Glucose homoeostasis in chronic liver disease.

The association between liver disease and abnormalities of carbohydrate metabolism has long been recognized. Although other defects exist, disturbance of blood glucose homoeostasis is most commonly noted. Hypoglycaemia is a practical problem only in acute hepatitis and fulminant hepatic failure, when it is a direct manifestation of massive acute loss of normal hepatocellular function. Fasting hyperglycaemia and impaired glucose tolerance occur in at least 50% of patients with established hepatic cirrhosis [ 1-31. Naunyn [4] hypothesized that pancreatic insulin secretion was adequate but that some effect of the liver damage itself was responsible for the impairment of carbohydrate metabolism, leading to the name ‘hepatogenous’ diabetes. This hypothesis was supported by observation of elevated serum levels of immuno-reactive insulin in chronic liver disease of any aetiology [ 1,2 ,5 ,6] . Doubts about the biological activity of immuno-reactive insulin in cirrhotic patients have recently been raised [7] and a reappraisal of current evidence is required.