The double glucagon test, a new liver function test (original) (raw)
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Glucagon and glucose tolerance in liver cirrhosis
European Journal of Endocrinology, 1988
The present study was undertaken in order to establish the significance of glucagon in glucose intolerance in liver cirrhosis. The plasma glucose response to an oral glucose load (75 g) was determined in 10 control subjects and in 10 cirrhotic patients, after infusions of: glucagon (3 ng\ m=. \ kg\ m=-\ 1\ m=. \ mi n\ m=-\ 1) or saline (154 mmol/l); somatostatin (SRIH) (500 \g=m\g/h);and SRIH plus glucagon (3 ng\ m=. \ kg\ m=-\ 1\ m=. \ mi n\ m=-\ 1). Glucagon infusion did not impair glucose tolerance, neither in normal subjects nor in patients with cirrhosis. On the other hand, in both groups glucose tolerance was impaired by SRIH infusion, presumably owing to an absolute insulin deficiency. Both in normal subjects and in cirrhotic patients, SRIH plus glucagon infusion further impaired glucose tolerance, presumably as a result of excess glucagon and concomitant insulin deficiency. In conclusion, our data show that hyperglucagonemia is not an important factor in the development of the glucose intolerance in patients with hepatic cirrhosis. Cirrhosis of the liver is characterized by an altered glucose tolerance (Megyesi et al. 1967; Samaan et al. 1969), an increased concentration of insulin in the peripheral blood (
Gastroenterologia Japonica, 1989
A cooperative study was conducted to determine the efficacy of one week of treatment with infusion of 1 mg glucagon and 10 units insulin twice daily in severe acute hepatitis. Ninty-eight patients with either prothrombin time less than 60% or thrombotest or hepaplastin test less than 50% of normal were randomly assigned to hormone or placebo treatment. SGOT and SGPT values dropped after treatment with a gradual decrease or increase in total serum bilirubin or cholesterol levels similarly in both groups receiving hormone or placebo. Deranged prothrombin time improved more rapidly in the hormone group than in the placebo group. Glucagon and insulin infusion may stimulate recovery of the liver from injury.
STUDY OF COMPARISON OF LIVER FUNCTION TESTS IN DIABETES CASES AND NON- DIABETICS CONTROLS
Introduction: diabetes is a metabolic disorder characterized by increased levels of blood glucose due to impairment in insulin action and/or insulin secretion. Liver plays a major role in the regulation of carbohydrate metabolism. It uses glucose as a fuel, store glucose as glycogen; also synthesize glucose from non-carbohydrate sources. Therefore, liver is more susceptible to diseases. Materials and methods: the study comprises of 100 subjects, out of whom 50 were diabetic cases and 50 non-diabetic control subjects. The subjects were those attending outdoor and indoor in New Medical College Hospital Kota, Rajasthan, India. Liver function test estimation by various methods mentioned above on fully automatic analyzer.Quantitative data was summarized in the form of mean ? sd and differences in means of both the groups were analyzed by unpaired student?t? test using graph pad prism.P-value less than 0.05 were considered significant. Results: the mean activity of serum bilirubin total (1.74 ? 0.897), bilirubin direct (0.474 ? 0.264), serum ast (62.56 ? 39.84 iu/l), serum alt (49.38 ? 45.85 u/l) and serum alp (134.32 ? 67.7 iu/l) of diabetic patients shows significant difference from that of normal subjects. Conclusion: the outcome of the present study shows that liver enzymes have higher activity in dm patients than controls. Thus screening for liver dysfunction in diabetics and subsequent workup may lead to early detection of hepatic co-morbidities and better management.
Liver Function Tests in Diabetic Patients
Diabetes Care, 1984
Nine different liver function tests (LFT) were assessed in 175 unselected diabetic outpatients stabilized on diet, insulin, or oral hypoglycemic drugs. In another group of 72 diabetic inpatients having diagnostic liver biopsy, relationships between LFT and histologic changes in the liver were investigated. Abnormalities in at least one of the tests were noted in 57% of the outpatients, and two tests gave pathologic results in 27%. The non-insulin-dependent diabetic patients more often had abnormal LFT results than did the insulin-dependent diabetic patients. Serum chenodeoxycholic acid concentrations were increased in 27%, γ-glutamyl transpeptidase (gGT) activities in 19%, and alanine aminotransferase (Alt) activities in 17% of the outpatients, but the increases were rarely more than twice the upper limit of normal. In multivariate analysis, outpatients who were overweight, showed poor diabetes control during a short duration of diabetes controlled by treatment with diet or oral age...
Insulin and glucagon levels in liver cirrhosis
Digestive Diseases and Sciences, 1979
Alterations in insulin and glucagon levels might account for the plasma amino acid imbalance of cirrhotics. In order to verify this hypothesis we evaluated basal insulin, glucagon, branched-chain amino acids, aromatic amino acids, and free tryptophan in 13 controls and37 cirrhotics divided on the basis of their mental state; in 4 patients the hormonal and amino acid patterns were sequentially studied during various stages of encephalopathy. Glucagon is high in cirrhotics and progressively increases with the worsening of the mental state. Free tryptophan and aromatic amino acids show a similar behavior and significantly correlate with glucagon levels (r = 0.67 and r = 0.81, respectively). On the other hand insulin levels, which are high in eirrhotics without encephalopathy, fall in the presence of deep coma. Insulin did not correlate with any of the plasma amino acids considered. Our data suggest that the catabolic state associated with increased glucagon levels may account for some of the alterations in the plasma amino acid profiles of cirrhotics. Portal-systemic shunting does not seem to be the common cause of both hyperglucagonemia and hyperaminoacidemia. Decreased branched-chain amino acid levels may be related to factors different from those involved in the alterations of carbohydrate homeostasis.
A review on laboratory liver function tests
Laboratory liver tests are broadly defined as tests useful in the evaluation and treatment of patients with hepatic dysfunction. The liver carries out metabolism of carbohydrate, protein and fats. Some of the enzymes and the end products of the metabolic pathway which are very sensitive for the abnormality occurred may be considered as biochemical marker of liver dysfunction. Some of the biochemical markers such as serum bilirubin, alanine amino transferase, aspartate amino transferase, ratio of aminotransferases, alkaline phosphatase, gamma glutamyl transferase, 5' nucleotidase, ceruloplasmin, α-fetoprotein are considered in this article. An isolated or conjugated alteration of biochemical markers of liver damage in patients can challenge the clinicians during the diagnosis of disease related to liver directly or with some other organs. The term "liver chemistry tests" is a frequently used but poorly defined phrase that encompasses the numerous serum chemistries that can be assayed to assess hepatic function and/or injury.
Diabetologia, 1979
The portal vein was catheterized via the umbilical vein under local anaesthesia in 10 nondiabetic subjects about to undergo exploratory laparotomy and in 8 patients with liver cirrhosis. Immunoreactive insulin (IRI) and glucagon (IRG) were assayed in portal and peripheral blood before and during IV infusion of glucose (0.33 g/kg) or arginine (25 g). Basal peripheral plasma (IRI) levels were raised in cirrhotic patients (19 + 2 versus 10 _+ I gU/ml; P < 0.001). Basal portal insulin values, however, did not differ in the two groups. After glucose cirrhotic patients had higher peripheral insulin concentrations, compared to controls, significant at 45 and 60 minutes. In contrast portal insulin levels were higher in controls than in cirrhotics by 1 minute (403 + 43 versus 158 • 38 ~tU/ml; P < 0.001) and remained so for the 60 minutes of study. Similarly, after arginine cirrhotics had significantly higher peripheral insulin concentrations and lower portal concentrations than controls. Peak portal vein insulin levels were delayed in cirrhotics (168 __+ 16 ~tU/ml at 3 min) compared with controls (413 + 25 ,uU/ml at 1 min). In the basal state both portal and peripheral glucagon levels were higher in cirrhotics than control subjects. Unlike in controls, 1V glucose did not suppress glucagon secretion in cirrhotic patients. Peripheral plasma glucagon concentrations after arginine were also consistently higher in cirrhotics than controls, but unlike insulin portal venous glucagon levels were also raised (1800 _+ 360 pg/ml, cirrhotics; 960 _+ 87 pg/ml, controls; P < 0.001; 1 min after arginine infusion). We conclude that insulin secretion is decreased in liver cirrhosis and that the peripheral hyperinsulinaemia observed reflects diminished hormone metabolism. The high plasma glucagon levels observed in cirrhotic patients are the result of pancreatic hypersecretion of glucagon.
LIVER FUNCTION TESTS PROTOCOL AND SIGNIFICANCE.
Biochemistry is the fascinating science, the Basis of Medicine,extensively useful to understand the diseases at molecular level This paper aims in giving state-of-the-knowledge review on liver functions and tests by descriptive diagrams and flow charts The article gives a bird?s eye view on various basic Biochemical aspects on functions of liver and metabolic reactions involved along with panel of tests. Imbalance /dysfunction / malfunctions of metabolic reactions of liver lead to diseases with clinical manifestations Disorders, Biochemical basis of the disorders, salient biochemical parameters, their levels in health and disease at one roof, aids the budding doctors to diagnose for onward appropriate treatments in treating the diseases.
Deranged Liver Function Tests in Type 2 Diabetes: A Retrospective Study
Background: Liver associated disorders like altered LFTs such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gammaglutamyltranspeptidase (GGT) in the serum, fatty liver disease, cirrhosis, hepato-cellular carcinoma and acute liver failure are a common occurrence in type 2 DM. Aim and Objective: To assess the association between liver function parameters and type 2 diabetes (T2D) in a north Indian population. Material and Methods: The study was conducted among 133 Type 2 DM patients in the department of Biochemistry, Pt. B.D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India. Data from type 2 DM diagnosed patients was retrospectively reviewed. Reports of outpatient fasting serum glucose and LFTs (which included serum levels of total bilirubin, AST, ALT, ALP, and albumin) were compiled. LFTs were advised to these patients as a part of routine screening. Results: It was found that the frequencies of elevated Bil, elevated ALT, elevated AST, elevated ALP and diminished albumin were 31.5%, 52.6%,59.3%, 42.1% and 73.6% respectively in the Type 2 DM cases. Moreover, the concentration of S. ALP correlated significantly with the random serum glucose levels. The correlation was significantly positive in the diabetic cases (r = 0.20, P < 0.05). Conclusion: The current study highlights the importance of liver function monitoring in patients with type 2 DM. This report would be helpful inencouraging the clinicians to give interest in monitoring this neglected diabetic hepatic complication in individuals suffering from type 2 DM.