Both insulin sensitivity and glucose sensitivity are impaired in patients with non-diabetic liver cirrhosis

Background: Careful nutritional support is required in patients with liver cirrhosis due to their glucose intolerance. To elucidate the mechanism of g lucose intolerance in cirrhotics, we measured insulin secretion, whole body insulin sensitivity (SI), and glucose sensitivity (SG) in non-diabetic cir rhotics. Methods: Fight patients with compensated cirrhosis who showed normal fastin g blood glucose levels and non-diabetic curves on a 75 g oral glucose toler ance test participated in this study. Four normal volunteers were selected as controls. After an overnight fast, glucose was injected intravenously at 300 mg kg(-1) in 2 min followed 20 min later by intravenous insulin at 0.0 2 U kg(-1) in 5 min. Sequential blood samples were drawn fi om 20 min befor e the glucose injection to 3 h post-injection, and plasma glucose and insul in levels were determined. Plasma glucose and insulin disappearance curves were analyzed using the minimal compartment model, and kinetic parameters, including glucose clearance (KG), insulin secretion, SI and SG, were estima ted. Results: KG was slower ill cirrhosis than in controls, although not signifi cant (P = 0.051). Insulin secretion was not different between the two group s, However, SI was significantly lower in cirrhotics (0.814 x 10(-4) min(-1 ) pM(-1); 0.572-1.403 x 10(-4) min(-1) pM(-1)) as compared to controls (1.6 43 x 10(-4) min(-1) pM(-1); 0.678-2.085 x 10(-4) min(-1) pM(-1)) (P = 0.029 ). SG was also lower in the cirrhosis (0.0154 min(-1): 0.0071 0.0208 min(-1 )) than in the control group (0.0211 min(-1); 0.0184-0.0260 min(-1)) (P=0.0 26). Conclusion: Both SI and SG are already impaired in non-diabetic cirrhotic p atients even when KG is minimally delayed and insulin secretion has not yet been affected. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.