Insulin sensitivity in alcoholic cirrhosis

Abstract

The amount-of-substance rate of glucose metabolism and its sensitivity to the concentration of insulin was quantified in 10 non-diabetic patients with alcoholic cirrhosis of varying severity, using the ‘glucose clamp technique’. Fasting glucose and insulin were 5.4±0.3 mmol/1 and 187±50 μmol/1 (mean ± SEM), respectively. During the hyperglycaemic clamp (blood glucose at 12.5 mmol/1) the glucose metabolic rate (divided by body mass) was 27± 4 μmol·min⁻¹·kg⁻¹ at an insulin concentration of 998± 158 pmol/1. Thus the insulin sensitivity of the tissue glucose metabolism was 22±7 m³·min⁻¹·kg⁻¹. During the euglycaemic clamp exogenous insulin was given to a concentration of 574± 72 pmol/1. The resulting glucose metabolic rate was 20± 4 μmol·min⁻¹·kg⁻¹ and the insulin sensitivity the same as during hyperglycaemia. The calculated systemic delivery rate of insulin (divided by body surface area) was 783± 172 pmol·min⁻¹·m⁻². Fasting glucagon was 32± 5 pmol/ and only partly depressed by glucose or insulin. In comparison with stated relevant control groups cirrhotics exhibit glucose intolerance characterized by decreased sensitivity to insulin, hyperinsulinaemia due to increased release, and hyperglucagonaemia with decreased suppressibility. There was no relation between clinical or biochemical data of the patients and the above results, suggesting that the abnormal glucose metabolism does not depend directly on the decreased liver function but on a disturbed pancreatic-hepatic-peripheral axis.

Key-words:

• glucagon
• glucose
• insulin resistance
• liver function
• metabolism