INFLUENCE OF INSULIN ON GLUCOSE-METABOLISM AND LIPOLYSIS IN ADIPOSE-TISSUE IN-SITU IN PATIENTS WITH LIVER-CIRRHOSIS

The influence of insulin on lipolysis and glucose metabolism in abdomi nal adipose tissue was studied in situ with the microdialysis techniqu e during a euglycaemic insulin clamp (1 mU kg(-1) min(-1)) in nine cir rhotic patients and 10 controls. The cirrhotic patients displayed a 50 % decrease in glucose utilization rate during the clamp (P < 0.001). D ialysate glucose levels decreased similarly by 20-30%, in patients and controls, which in the presence of unchanged local blood flow in the adipose tissue in response to insulin, is at hand with a glucose uptak e into the adipocytes of similar magnitude in both groups. Before and during the clamp, the arterial and dialysate levels of glycerol were h igher in the patients than in the control subjects (ANOVA P = 0.001 an d 0.048 in arterial blood and dialysate, respectively). In relative te rms, however, insulin induced a 70% reduction of arterial and dialysat e glycerol in both groups. The concentrations of lactate and pyruvate in the dialysate and blood increased in a similar way in both groups d uring hyperinsulinaemia. The results suggest an increased rate of lipo lysis in cirrhotic patients. Insulin cannot lower it to normal, althou gh it is still capable of achieving a relative reduction. No explanati on was found in the adipose tissue to the insulin resistance to whole- body glucose utilization that was noted in the patients with cirrhosis .