Hipoinsulinemia em alcoolistas com hepatopatia mínima

Abstract

The chronic pancreatitis (CP) may evolve with low insulin levels and develop clinical picture of diabetes mellitus. Low seric levels of insulin and C peptide after stimulus has also been described in asymptomatic alcoholics even with normal glicemic curves. It is known that the chronic alcoholism is the main etiological factor of CP and hepatic diseases, and that the insulin produced by the pancreas is metabolized mainly by the liver. High levels of periferic insulin are described in hepatic cirrhosis due to decrease of hepatic metabolization alone or associated to increase of periferic resistence. AIM: In alcoholics with minimal hepatic lesions to evaluate the seric insulin and glucose levels after stimulus with intravenous glucose. METHODS: In 8 alcoholic patients with minimal hepatic lesions characterized by hepatic biopsy, and 26 non-alcoholics, healthy controls, it was studied the serum glucose and insulin levels in basal time, 1, 3, 5, and 10 minutes after stimulus with intravenous glucose (0.5 g/kg). RESULTS: The insulin means in time 1, 3 minutes and total integrated response after stimulus were lower (p < 0.05) in alcoholic group than in control, even with normal glucose curves. CONCLUSION: Alcoholics with minimal hepatic lesions showed low seric insulin levels after glucose stimulus, similar to former observations in asymptomatic alcoholics, indicating hypofunction of pancreatic B cells.

OBJETIVO: Em alcoolistas portadores de lesões hepáticas mínimas avaliar os níveis de glicose e insulina séricas após estímulo com glicose intravenosa. MÉTODOS: Em oito etilistas, portadores de alterações hepáticas mínimas, caracteriza por biópsia hepática, e em 26 controles sadios não-alcoólicos, foram estudados os níveis glicêmicos e insulinêmicos (RIE) nos tempos 1, 3, 5, e 10 minutos após estímulo com glicose intravenosa (0.5g/Kg de peso). RESULTADOS: As médias da insulina sérica dos tempos 1, 3 minutos e resposta integrada total (RIT-10min) após estímulo foram menores no grupo alcoolista em relação ao controle (p < 0,05) apesar de curvas glicêmicas normais. CONCLUSÃO: Etilistas crônicos com lesões hepáticas mínimas, à semelhança do observado anteriormente em etilistas assintomáticos, apresentam níveis diminuídos de insulina sérica, mas com curvas glicêmicas normais, após estímulo com glicose intravenosa, indicando hipofunção de células beta do pâncreas.