Insulin resistance (IR), a prevalent complication in the perioperative period, significantly impacts patient outcomes, and its pathogenesis may be related with insulin signaling pathways disrupted by surgical stress, inflammatory responses, and metabolic changes. Effective nutritional management is critical for reversing IR during this period. In this article, we elucidated the epidemiology and pathophysiology of perioperative IR, discussed the impact of different nutrition intervention strategies on the condition, such as preoperative nutritional assessment, hypoglycemic agents, and enhanced recovery after surgery protocols, and focused on the role of fatty acids in modulating the resistance. Furthermore, we reviewed the recent progress on perioperative nutritional management, aiming to provide reference for the prevention and management of perioperative IR.