[Hyperinsulinemia in cirrhosis--increased secretion or impaired liver extraction?]

The authors applied the oral glucose tolerance test (oGTT) in 21 patients with bioptically confirmed cirrhosis without clinical or laboratory signs of manifest diabetes. At the same time they used the oGTT in 11 healthy controls. During the test they assessed the venous glycaemia, insulin and C-peptide and from these values they calculated relative indexes. In cirrhotic patients they recorded during the oGTT higher blood sugar levels, and higher insulin and C-peptide in the majority of time intervals [blood sugar during the 90th minute p greater than 0.01 and 120th minute p greater than 0.05; immunoreactive insulin (IRI) in the 90th minute p greater than 0.05 and in the 120th minute p greater than 0.01), i.e. typical hyperinsulinaemia with a retarded secretory maximum during the 90th minute. The calculation of the molar ratio C-peptide: IRI is considered useful by the authors. In cirrhotic patients it was markedly reduced on fasting, during the 60th, 90th and 120th minute (p greater than 0.01). In the discussion the authors analyze the problem of enhanced insular secretion, impaired hepatic extraction and insulin resistance in relation to disorders of glucose tolerance in cirrhosis.