INSULIN RESPONSES AND ITS HEPATIC EXTRACTION WITH INTRAVENOUS GLUCOSE AND GLUCAGON STIMULATION IN OBSTRUCTIVE JAUNDICE

Intravenous glucose tolerance test (IV-GTT) was studied in 20 patients with obstructive jaundice and 15 normal subjects as control. Glucagon test was studied in 15 patients with obstructive jaundice and 13 normal subjects as control. The obstructive jaundice group had no initial insulin rise after glucose stimulation but moderate initial insulin rise after glucagon stimulation. It is considered that the insulin secretion mechanism with glucose stimulation is different from that with glucagon stimulation. Experimentally, the changes of insulin level in portal- and peripheral-vein, and its hepatic extraction were studied in jaundiced dogs, which were made by ligation of the common bile duct 2 weeks before the study. IV-GTT and glucagon test were pei formed in 5 jaundiced dogs and 5 normal dogs as control respectively. After glucose stimulation, the jaundiced group had no initial insulin rise in peripheral and portal vein. But after glucagon stimulation, the jaundiced group had higher initial insulin rise in portal vein and lower initial insulin rise in peripheral vein than the control group. Accordingly, there is accelerated hepatic extraction of insulin on glucagon stimulation in obstructive jaundice.