A Study of Insulin Resistance and its Clinico-Metabolic Correlates by Modified Harano's Method in Euglycemic Cirrhotics

ABSTRACT

To study insulin resistance and its clinico metabolic correlates in 20 euglycemic cirrhotics by Modified Harano's method. 20 euglycemic cirrhotics (18 male and 2 female; 14 alcoholic & 6 post hepatitis B) and equal number of age, sex and BMI matched healthy controls of mean ± SD age 37.1±8.35 v/s 36.5±7.48 years and BMI 18.4±1.83 v/s 18.5±1.77 kg/m2 were enrolled. All subjects underwent 75 gram oral glucose tolerance test (OGTT) in a fasting state. Samples for glucose (0,30,60, 90 & 120 min) and insulin ( 0 & 120 min) were withdrawn. Assessment of insulin resistance was carried out by Insulin suppression test (Modified Harano's method) i.e. simultaneous infusion of glucose as 20% dextrose @ 6 mg/kg/min and plain human insulin @ 50 mU/kg/hr. Steady state plasma glucose (SSPG) and steady state plasma insulin (SSSI) of 120-150 min of infusion were determined. Metabolic clearance rate for glucose (MCR) calculated as rate of glucose infusion/SSPG and insulin clearance rate (ICR) as rate of insulin infusion/SSSI. Lower the MCR and ICR, higher is the state of IR. Correlations of MCR and ICR with various clinical and metabolic variables were then studied. The result of present study suggests that cirrhosis is an insulin resistant state with low clearance rates for glucose and insulin, significant higher levels of glucose and insulin in postprandial state and markedly low levels of lipids. The state of insulin resistance is independent of severity of hepatic decompensation as classified by Child-Pugh's classification, etiology, nutritional status, clinical state, liver function tests and serum lipids.