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/l and 187 +/- 50 pmol/l (mean +/- SEM), respectively. During the hyperglycaemic clamp (
blood glucose at 12.5 mmol/l) the
glucose metabolic rate (divided by body mass) was 27 +/- 4 mumol X min-1 X kg-1 at an
insulin concentration of 998 +/- 158 pmol/l. Thus the
insulin sensitivity of the tissue
glucose metabolism was 22 +/- 7 m3 X min-1 X kg-1. During the euglycaemic clamp exogenous
insulin was given to a concentration of 574 +/- 72 pmol/l. The resulting
glucose metabolic rate was 20 +/- 4 mumol X min-1 X 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 X min-1 X 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.