2017 Volume 60 Issue 7 Pages 498-506
We describe the case of a 67-year-old man with hepatogenous diabetes caused by alcoholic cirrhosis. He was admitted to our hospital due to hyperglycemia (HbA1c 9.4 %) and basal-bolus-therapy was initiated. Although the dose of insulin lispro was increased to 64 U/day, the patient's postprandial hyperglycemia persisted due to insulin resistance, which was associated with cirrhosis. Insulin was discontinued because the patient had allergic reactions to insulin at the injection site during insulin therapy and liraglutide and voglibose combination therapy was started. However, the patient's post-lunch and post-dinner hyperglycemia showed no improvement. Thus, exenatide treatment (three daily injections before each meal) was started. Thereafter, the patient's postprandial hyperglycemia showed an obvious improvement. To identify the factors correlated with the improvement of the patient's postprandial hyperglycemia after the injection of exenatide, an acetaminophen test and test meal loading were performed. As a result, the effect of exenatide on cirrhosis-related postprandial hyperglycemia was associated with a delay of gastric emptying and the suppression of glucagon secretion, which were physiological actions of GLP-1. In addition, a glucagon test to evaluate the hepatic glucose output may help to predict the extent to which glucagon affects postprandial hyperglycemia in patients with cirrhosis. No side effects of exenatide were observed. The administration of three daily injections of short-acting exenatide was effective for treating hepatogenous diabetes in a patient with cirrhosis.
