The glucoregulatory hormones in cirrhosis of the liver

Cirrhosis is complicated by numerous abnormalities of carbohydrate metabolism although these are seldom of clinical importance. Carbohydrate intolerance is extremely common and is accompanied by hyperinsulinaemia, hyperglucagonaemia and elevated levels of gluconeogenic precursors. The hyperinsulinaemia results from impaired hepatic degradation of insulin while recent evidence suggests that pancreatic hypersecretion is responsible for the elevated levels of glucagon in cirrhosis. The role of hepatocellular damage and portal-systemic shunting in the pathogenesis of these abnormalities is controversial but the derangements in carbohydrate metabolism probably reflect hepatocellular damage rather than portal-systemic shunting.