Research Article| Volume 73, ISSUE 1, P25-33, January 1969

Decreased insulin production, elevated growth hormone levels, and glucose intolerance in liver disease

      This paper is only available as a PDF. To read, Please Download here.


      Oral glucose tolerance (GTT) was investigated in 14 patients with liver disease and in whom IV galactose tolerance (GaTT) was used as a measure of liver function. Impairment of GTT was found in 1 of 5 patients with hepatitis and in 6 of 9 with cirrhosis. Impairment was closely correlated with impairment of GaTT. Blood glucose and immunoreactive insulin (IRI) levels during GTT in the 14 patients were correlated. IRI levels were the same as in normal subjects but occurred at higher blood glucose levels. The linear regression of IRI on blood glucose revealed that for similar increments in blood glucose, liver disease patients had less increase in IEI than that in normal subjects or diabetic patients with the same blood glucose levels. In cirrhotic subjects with clinical hyperestrogenism fasting immunoreactive growth hormone (GH) was elevated and did not decrease normally after glucose administration. IV galactose alone decreased these levels and appeared to potentiate the effect of glucose on GH. Fasting free fatty acid (FFA) levels were also elevated and did not decrease normally after glucose administration. In hepatitis GH and FFA levels were normal. Maturity-onset diabetic persons with the same degree of impairment of GTT had normal GaTT. Impaired GTT in liver disease is related to the degree of liver damage and is associated with decreased insulin production. Elevated GH and FFA levels do not correlate with glucose intolerance. The impaired insulin production might be explained by a deficiency in the intestinal or hepatic factors that stimulate insulin secretion during carbohydrate absorption.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Translational Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Megyesi C.
        • Samols E.
        • Marks V.
        Glucose tolerance and diabetes in chronic liver disease.
        Lancet. 1967; 2: 1051
        • Vannotti A.
        • Felber J.P.
        • Magnenat P.
        Reduced glucose tolerance and increased insulin response in cirrhosis.
        Schweiz. med. Wchnschr. 1967; 97: 1537
        • Darnis F.
        Studies of disturbances of glucose metabolism in chronic alcholic disease of the liver.
        Semaine hôp. Paris. 1967; 43: 2929
        • Somogyi M.
        Notes on sugar determination.
        J. Biol. Chem. 1952; 195: 19
        • Fales W.F.
        • Russell J.A.
        • Fain J.N.
        Some applications and limitations of the enzymic, reducing (Somogyi), and anthrone methods for estimating sugars.
        Clin. Chem. 1961; 7: 389
        • Dole V.P.
        A relation between non-esterifled fatty acids in plasma and the metabolism of glucose.
        J. Clin. Invest. 1956; 35: 150
        • Morgan C.R.
        • Lazarow A.
        Immunoassay of insulin. Two-antibody system: Plasma insulin levels of normal, sub-diabetic and diabetic rats.
        Diabetes. 1963; 12: 115
        • Schalch D.S.
        • Parker M.L.
        A sensitive double antibody immunoassay for human growth hormone in plasma.
        Nature. 1964; 203: 1141
        • Danowski T.S.
        • Gillespie H.K.
        • Fergus E.B.
        • Puntereri A.J.
        Significance of blood sugar and serum electrolyte changes in cirrhosis following glucose, insulin, glucagon and epinephrine.
        Yale J. Biol. Med. 1957; 29: 361
        • Goetz F.C.
        • Maney J.W.
        • Greenberg B.Z.
        The regulation of insulin secretion: Effects of the infusion of glucose, ribose, and other sugars into the portal vein of dogs.
        J. Lab. & Clin. Med. 1967; 69: 537
        • Unger R.H.
        • Ketterer H.
        • Dupré J.
        • Eisentraut A.
        Effect of secretin on insulin secretion.
        Lancet. 1966; 2: 24
        • Mucci A.
        • Zandomeneghi R.
        • Mezzelani P.
        L'attivita similinsulinica del siero in corso di cirrosi epatica.
        Acta Diab. Latina. 1967; 4: 397
        • Chlouverakis G.
        • Harris P.
        Non-esterified fatty acids and lipoprotein lipase activity in patients with cirrhosis of the liver.
        Gut. 1961; 2: 233
        • Mendenhall C.L.
        • Morteaux A.
        Alterations in serum triglyceride levels in liver disease.
        Gastroenterology. 1962; 42: 684
        • Sullivan J.F.
        • Swartz M.J.
        • Robertson P.R.
        Hyperlipemia in Laennec's cirrhosis.
        Am. J. Med. Sc. 1963; 246: 451
        • Greenough W.B.
        • Crespin S.R.
        • Steinberg D.
        Hypoglycemia and hyperinsulinemia in response to raised free fatty acid levels.
        Lancet. 1967; 2: 1334
        • Schalch D.S.
        • Kipnis D.M.
        The impairment of carbohydrate tolerance by elevated plasma free fatty acids.
        J. Clin. Invest. 1964; 43: 1238
        • Garcia J.F.
        • Linfoot J.A.
        • Manougian E.
        • Born J.L.
        • Lawrence J.H.
        Plasma growth hormone studies in normal individual and acromegalic patients.
        J. Clin. Endocrinol. 1967; 27: 1395
        • Schwartz E.
        • Echemendia E.
        • Schiffer M.
        Peripheral metabolic antagonism of estrogen and human growth hormone.
        J. Clin. Invest. 1967; 46 (Abst.): 1115
        • Glick S.M.
        • Roth J.
        • Yalow R.S.
        • Berson S.A.
        Regulation of growth hormone secretion.
        Rec. Progr. Hormone Res. 1965; 21: 241
        • Pimstone B.
        • Barbezat G.
        • Hausen J.D.L.
        • Murray P.
        Growth hormone and protein-calorie malnutrition.
        Lancet. 1967; 2: 1333
        • Samaan N.
        • Pearson O.H.
        • Gonzalez D.
        • Llerena O.
        Paradoxical secretion of growth hormone in patients with breast cancer.
        J. Lab. & Clin. Med. 1966; 68 (Abst.): 1011