Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives

Figure 1 Pathophysiology of hepatogenous diabetes in cirrhotic liver. Hepatogenous diabetes develops directly from insulin resistance in the liver, and indirectly from impaired glucose metabolism due to insulin resistance in muscle. Hyperinsulinemia can result from reduced insulin clearance by the damaged liver and the presence of portosystemic shunts. With progression of diabetes, there is a reduction in the sensitivity of pancreatic b cells due to glucotoxicity, and reduced production of insulin. IGF: Insulin-like growth factor.