Effects of intra- and extrahepatic shunting on insulin metabolism and glucose tolerance

To study the effects of intra- and extrahepatic shunting on insulin metabolism and glucose tolerance, 12 patients with liver diseases were studied with intravenous infusion of 0.5gm glucose per kilogram of ideal body weight and intra- and extrahepatic shunting was measured in these subjects. With glucose stimulation, portal vein blood level of insulin showed a peak at 2 minutes and again at 15-90 minutes. Values for glucose disappearance rate (KG) showed a more significant correlation with insulin consumed (area under curve or AUC060 for portal blood IRI-AUC060 for peripheral blood IRI) than insulin secreted (AUC060 for portal blood IRI). Whole body IRI extraction ratio (AUC060 for portal blood IRIAUC060 for peripheral blood IRI)/(AUC060 for portal blood IRI)×100 showed a significant correlation with intrahepatic shunting but did not show a significant correlation with extrahepatic shunting. These data suggest that a decrease of metabolism of insulin due to intrahepatic shunting may play a role, at least, in part, in glucose intolerance in patients with chronic liver disease, especially liver cirrhosis.