Patterns of glucose intolerance and free fatty acid behavior in viral hepatitis

Twenty-one viral hepatitis patients underwent i.v. glucose tolerance tests during the acute phase of the illness. The results, expressed as the constant of glucose disappearance (Kg), were compared with those of 10 healthy control subjects. When the patients were grouped according to Kg-less than 0.9 or greater than 1.2 min-1-it was found that eight showed a delayed glucose disappearance together with a moderate hypoinsulinemic response (pattern 1). Another eight showed a normal glucose disappearance together with a hyperinsulinemic response (pattern 2). Five patients had intermediate Kg values. High levels of plasma free fatty acids (FFA) were a consistent finding in all patients, indicating that unrestrained lipolysis is an important feature of hepatitis. The extent of decrease in plasma FFA in response to the glucose load was markedly lower in all hepatitis patients than in the control subjects; the rate of decrease was most delayed in the pattern 1 patients. This suggested that the increased FFA availability is an expression of adipose tissue insulin resistance, which, in contrast to glucose disappearance, remains uncompensated by the relative hyperinsulinemia. It may contribute to the diminished peripheral glucose utilization, particularly in pattern 1 patients. We conclude that the different patterns of response in hepatitis may be discerned in one patient group by extending the diagnostic criteria of the glucose tolerance test. In addition to the differences in the magnitude of the peripheral insulin resistance, the main distinction between the two patterns lies in the capacity of the pancreas to adjust insulin secretion in order to maintain normal glucose homeostasis.