Postoperative delirium presents a significant challenge for surgical teams because it often leads to prolonged hospitalization. Consequently, clinicians are actively seeking effective interventions to safeguard cognitive health. A recent systematic review suggests that **intranasal insulin postoperative delirium** prevention is a highly effective strategy. This treatment reduces the incidence of delirium by approximately 64% among adult surgical patients.

Notably, the meta-analysis analyzed data from nine randomized controlled trials involving 1,039 patients. Patients receiving intranasal insulin demonstrated a markedly lower risk ratio of 0.36 compared to those receiving a placebo. Furthermore, subgroup analyses highlighted consistent benefits across orthopedics, gastrointestinal, and cardiac surgeries. Additionally, the researchers observed no significant safety concerns or increased risk of systemic hypoglycemia.

Benefits of **Intranasal Insulin Postoperative Delirium** Prevention

The primary mechanism of action involves insulin's potent neuroprotective and anti-inflammatory properties. Specifically, intranasal delivery allows insulin to bypass the blood-brain barrier and directly target the central nervous system. Therefore, it effectively modulates neuroinflammation by decreasing pro-inflammatory cytokines like interleukin-6 and tumor necrosis factor-alpha. Moreover, it enhances cerebral glucose metabolism, which typically falters during the high-stress perioperative period.

However, despite these promising results, standard treatment protocols do not yet universally include intranasal insulin. Nonetheless, the evidence strongly supports its potential to improve cognitive recovery and reduce morbidity. Similarly, larger multicenter trials will likely clarify the optimal dosing and timing for various patient populations in the near future.

Does intranasal insulin cause low blood sugar?

No. Clinical studies indicate that intranasal insulin doses up to 160 IU do not significantly increase the risk of systemic hypoglycemia, as the delivery is primarily targeted to the brain.

Which surgical patients benefit most from this treatment?

The meta-analysis indicates significant risk reduction in patients undergoing cardiac, orthopedic, and gastrointestinal procedures, where delirium incidence is historically high.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider for any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.

References

Desai A et al. Efficacy of intranasal insulin in reducing the incidence of postoperative delirium: A systematic review and meta-analysis of randomised controlled trials. J Perioper Pract. 2026 Feb 22. doi: 10.1177/17504589261421004. PMID: 41723589.

Zhang H et al. Intranasal insulin and postoperative delirium in adult surgical patients: a meta-analysis and systematic review of randomized controlled trials. Front Med (Lausanne). 2025 Nov 12;12:1670982. doi: 10.3389/fmed.2025.1670982.

Zhang Y et al. Effects of intranasal long-acting insulin pretreatment on postoperative delirium and the NLRP3/caspase-1/IL-1β pathway in older patients with esophageal cancer. Sciety. 2025. url: https://sciety.org/articles/10.1101/2024.12.30.24319458.

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