glucose is the major source of fuel used to generate cellular energy in the form of ATP,which in turn powers the wound healing process. the use of glucose to generate ATP is thought to be relatively inefficient, but the caloric contribution of glucose is essential in preventing the depletion of other amino acid and protein substrates. the liver, triggered by cortisol surge of wounding, initiates gluconeogenesis using amino acids from degraded muscle protein. unchecked and in the presence of inadequate carbohydrates and fat stors,this use and depletion of amino acid and protein can lead to the protein-calorie malnutrition previously described.carbohydrates play an important role in providing the energy essential for optimal healing, but little is known about the function that different sources of carbohydrates play in this process. gluconeogenesis is an inefficient pathway for glucose production and can result in the production of excess amount of glucose ,which may complicate wound healing, especially in diabetic patients with poor glycemic control.