The aims of this study are: 1) to measure total systemic glucose output and gluconeogenesis in patients with cirrhosis and indirectly estimate glycogenolysis during fasting; 2) to evaluate the sensitivity of gluconeogenesis and, indirectly, glycogenolysis, to the action of exogenous glucagon while endogenous insulin and glucagon are suppressed by an infusion of somatostatin; 3) to measure the rate of proteolysis and protein oxidation and urea synthesis during fasting; and 4) to quantify total energy expenditure and the type of substrates oxidized during fasting in cirrhotics and age/sex matched controls and to relate them to the liver size. The hypotheses are: 1) in order to maintain basal glucose production, gluconeogenesis in cirrhotic patients is increased; 2) elevated plasma glucagon levels contribute to this increase in gluconeogenesis; and 3) the increased rate of gluconeogenesis is sustained by increased muscle proteolysis and protein oxidation leading to muscle protein wasting. A preliminary data analysis was conducted after the first 2 patients and 2 control subjects were studied. There was no difference in gluconeogenesis which we hypothesize is the result of the 24hr glucose infusion masking any differences in the two groups. The protocol was modified to add a test day without glucose loading.
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