SPLANCHNIC AND PERIPHERAL GLUCOSE-METABOLISM IN CIRRHOSIS

The effects of glucose and insulin administration on splanchnic and leg exchange of glucose were investigated in seven patients with cirrhosis and six sex- and age-matched healthy controls using the catheter technique. 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 splanchnic glucose output tended to be lower in patients than in controls (0.50+/-0.16 vs 0.73+/-0.11 mmol/min nonsignificant), as did leg glucose uptake (0.06+/-0.01 vs 0.08+/-0.02 mmol/min, non-significant), Glucose infusion resulted in a significant rise in leg glucose uptake, while net splanchnic glucose output decreased in both groups. During the euglycemic insulin clamp, insulin concentrations rose to 110+/-10 and 80+/-8 mu U/ml in patients and controls, respectively. C-peptide concentrations decreased in the healthy controls but were unchanged from the basal level in patients with cirrhosis. Glucose disposal during the last half hour of the clamp was 1.12+/-0.08 and 3.19+/-0.04 mmol/nin in patients and controls, respectively (p<0.001). Glucose was taken up by the splanchnic region in both groups but this uptake was significantly 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. The results demonstrate that cirrhosis is accompanied by severe insulin resistance in peripheral tissues but not in the splanchnic region. The increased splanchnic glucose uptake during the euglycemic clamp may serve to facilitate repletion of hepatic glycogen stores in cirrhosis. (C) Journal of Hepatology.