SPLANCHNIC AND PERIPHERAL GLUCOSE-METABOLISM IN CIRRHOSIS

The effects of glucose and insulin administration on splanchnic and le g exchange of glucose were investigated in seven patients with cirrhos is and six sex- and age-matched healthy controls using the catheter te chnique. After a basal period, glucose infusion (1 mg.kg(-1).min(-1)) was given for 45 min, followed by a 2-h euglycemic insulin clamp (1 mU .kg(-1).min(-1)). In the basal state insulin levels were significantly higher in patients than in controls (25+/-4 vs. 7+/-2 mu U/ml). Net s planchnic glucose output tended to be lower in patients than in contro ls (0.50+/-0.16 vs 0.73+/-0.11 mmol/min nonsignificant), as did leg gl ucose uptake (0.06+/-0.01 vs 0.08+/-0.02 mmol/min, non-significant), G lucose infusion resulted in a significant rise in leg glucose uptake, while net splanchnic glucose output decreased in both groups. During t he euglycemic insulin clamp, insulin concentrations rose to 110+/-10 a nd 80+/-8 mu U/ml in patients and controls, respectively. C-peptide co ncentrations decreased in the healthy controls but were unchanged from the basal level in patients with cirrhosis. Glucose disposal during t he last half hour of the clamp was 1.12+/-0.08 and 3.19+/-0.04 mmol/ni n in patients and controls, respectively (p<0.001). Glucose was taken up by the splanchnic region in both groups but this uptake was signifi cantly greater in patients than in controls (0.42+/-0.05 vs. 0.25+/-0. 06 mmol/min, p<0.05). In contrast, leg uptake was significantly lower in patients (0.16+/-0.04 mmol/min) than in controls (0.68+/-0.13 mmol/ min, p<0.01) in spite of the former's higher insulin concentrations. T he results demonstrate that cirrhosis is accompanied by severe insulin resistance in peripheral tissues but not in the splanchnic region. Th e increased splanchnic glucose uptake during the euglycemic clamp may serve to facilitate repletion of hepatic glycogen stores in cirrhosis. (C) Journal of Hepatology.