Question

1. Hypoglycemia is a symptom commonly observed in cirrhotic patients. What is the physiological basis for this? How might this affect nutritional status?

Answer 1

Ans) Cirrhosis of the liver increases an individual’s energy expenditure because of
vasodilation and an expansion in blood volume. Because of this phenomenon, blood
sugar levels can be erratic in patients with cirrhosis of the liver.

- When cirrhosis reaches levels at which 80% of hepatocytes (liver cells) are not functional, hypoglycemia is a common incidence due to hyperinsulinemia (high amounts of insulin in the blood). The potential problem is the lack of sufficient amounts of glycogen reserves as a result of liver damage may cause hypoglycemia after an overnight fast and may also prompt
recruitment of amino acids from the skeletal muscles for gluconeogenesis ( the metabolic
pathway through which glucose is formed form noncarbohydrate sources).

- Low glucose store could pose a problem because this could cause a patient to suffer from fatigue, heart palpitations, tremors, and sweating. This is the body’s reactions to
hypoglycemia because it is slowing down its processes. However, 40%-50% of all
patients with end-stage liver disease suffer from insulin-resistant diabetes mellitus which
means hyperglycemia may also be apparent.

- Fasting hypoglycemia can occur because of the decreased ability of glucose from glycogen in addition to the failing gluconeogenic capacity of the liver