Glucose Tolerance and Metabolic Changes in Human Viral Hepatitis

Abstract

1. Glucose tolerance and metabolic changes after intravenous glucose were studied in fifteen patients with acute viral hepatitis and in eight patients after recovery. In the acute stage glucose tolerance was significantly impaired compared with control subjects or with patients after recovery from hepatitis.2. Serum insulin concentrations were significantly higher in fasting acute hepatitis patients than in control subjects and the time-integrated serum insulin concentration in the first 5 min after glucose was inappropriately high for the observed glucose disappearance rate, indicating insulin resistance. Serum growth hormone concentrations in male acute hepatitis patients were significantly higher than controls and suppressed poorly.3. Fasting blood lactate concentrations were significantly elevated and after intravenous glucose there was a variable response. 2-OxoglutarateY glutamate and glutamine concentrations from blood of fasting subjects, were significantly higher in acute hepatitis patients than controls.4. There were no significant differences in blood ketones, glycerol and plasma free fatty acid concentrations from fasting subjects, but plasma triglycerides were significantly increased in the acute hepatitis patients.5. The results indicate that viral hepatitis is associated with glucose intolerance and insulin resistance. After recovery the lactate response after glucose is diminished compared with controls.

Reduced insulin binding to hepatic plasma membranes in D-galactosamine-treated rats

“…In acute virus hepatitis in man increased plasma insulin levels in addition to impaired glucose tolerance have been reported. These results were interpreted as an expression of insulin resistance due to a reduction in functionally normal hepatocytes [31,32].…”

Glucose Intolerance and Hepatic, Biliary Tract and Pancreatic Dysfunction

“…Although acute liver disease is rarely as sociated with insulin-dependent diabetes mellitus, transient glucose intolerance and hyperinsulinism are common [114][115][116][117], Hypoglycemia may occur with unusually se vere viral hepatitis when glycogenolysis and gluconeogenesis are impaired, but is difficult to demonstrate in studies of more typical cases of acute viral hepatitis [114][115][116][117]. In one study, 90% of the cases studied had either glucose intolerance or hyperinsulinemia.…”

“…Most patients with hyperinsulinemia had normal glucose tolerance. These data suggest that insulin resistance is common and that glucose intolerance depends on the ability of the pancreas to respond to insulin resistance by elevating serum insulin levels [114][115][116][117].…”

Glucose Tolerance and Insulin and Gastric Inhibitory Polypeptide Responses following Intraduodenal Glucose Loading in Dogs with Obstructive Jaundice

“…Glucose intolerance in liver disease has been well recognized since Naunyn first described what he called 'hepatogenous diabetes' [1]. It occurs commonly in cirrhosis [2][3][4], active chronic hepatitis [5], acute viral hepatitis [6], toxic hepatitis [7], and obstructive liver disease [8][9][10], Hyperinsulinemia af ter glucose loading appears to be associated with he patic cirrhosis [2,3,11], while hypoinsulinemia ap pears to be characteristic of obstructive liver disease [ 10].…”