American Research Journal of Medicine and Surgery

Background and Aims: Cirrhosis of liver is one of the commonest cause of ill health among general population particularly in chronic alcoholics in developing countries like India. Cirrhosis patients show increased incidence of hyperglycemia; to study impaired glucose tolerance in patient with cirrhosis & to predict prognosis of patients with Liver Cirrhosis.
50 Patients of liver cirrhosis of either sex and age were included in the study. All patient were subjected to oral glucose tolerance test and the findings were correlated with the severity of the disease.
Results: 16% patients belonged to child’s grade A, 50% belonged to grade B & 34% patients belonged to Child’s grade C. 56% of patients showed impaired glucose tolerance. No patient showed diabetic response to glucose tolerance test. 15 (88%) patients belonging to Child’s grade C showed impaired glucose tolerance. While there were 12 (48%) patients in Child’s grade B who showed impaired glucose tolerance. Only 1 (12.5%) patient in Child’s grade A had glucose intolerance.
Conclusion: The incidence of impaired glucose tolerance was significantly high among patients with cirrhosis of liver. This high incidence of glucose intolerance was not related to the age, sex and etiology but was related with the severity of disease.
Cirrhosis of liver is one of the commonest cause of ill health among general population particularly in chronic alcoholics in developing countries like India. Since it is a slowly progressive silent disease it is usually overlooked by the patient themselves unless they develop some complication. In India there has been a rise in case of post necrotic cirrhosis following hepatitis B infection.
Cirrhosis a generic term, includes all forms of chronic diffuse liver disease characterized by significant loss of liver cells, collapse and diffuse septal fibrosis of liver associated with regenerative parenchymal nodules and disturbed intrahepatic circulation. Cirrhosis results from prolonged and widespread but patchy hepatocellular necrosis which may have many cause (Oxford Textbook of Medicine 3rd edition, pg. 2085).1
Cirrhosis of liver causes significant derangement of carbohydrate metabolism. Narayan (1906) first time, established impairment of carbohydrate metabolism scientifically in liver disease including cirrhosis of liver. Impaired glucose tolerance is related to severity of liver disease and there is no evidence that DM predispose to cirrhosis. O Riggio et al. (1982).2 Glucose intolerance in cirrhosis is caused by simultaneous occurrence of insulin resistance in muscles and inadequate secretion of insulin by beta-cell of pancreas to overcome the insulin resistance (Petrides et al, 1994).3
Cirrhosis patients show increased incidence of hyperglycemia associated with increased insulin level. Hyperglycemia is explained by reduced absorption of glucose by muscles and decreased glycogen storage in liver and muscles. This leads to increased insulin level in serum and increased insulin resistance [Sleisenger & Fordtrans GI and liver ds. 6th Edi. Vol 2. Page 1067].4

Fasting blood glucose is usually normal in cirrhotics but most are insulin resistant and are intolerant to an oral glucose load, and have post prandial hyperglycemia (Oxford Textbook of Medicine, 3rd edition, Pg. 2088).1
In this study oral glucose tolerance test was done in patients of cirrhosis to demonstrate glucose intolerance and its correlation with the severity of cirrhosis.