Lack of Increase in Insulin Resistance after Portosystemic Surgical Shunt in Patients with Cirrhosis

To the Editor: Liver cirrhosis is considered an insulin-resistant state 1 on the basis of a combined receptorial and post-binding defect. 2 Hyperinsulinemia seems ascribable to reduced hepatic degradation of the hormone rather than to increased B-cell production. 3 In order to evaluate whether reduced hepatic degradation is due to portosystemic shunt or to hepatocellular damage, we studied 18 patients with nonascitic cirrhosis (liver biopsy) and impaired glucose tolerance (according to the criteria of the National Diabetes Data Group) and 18 age-matched and sex-matched controls. The only therapy in the patients was the use of spironolactone (100 to 200 mg per day). Each . . . No extract is available for articles shorter than 400 words.