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The ability of the liver to control blood glucose levels was studied in relation to the blood ketone body ratio, which reflects the hepatic mitochondrial redox state. In partially hepatectomized rabbits, postoperative continuous administration of a hyperosmolar glucose solution revealed the following findings: (1) The occurrence of glucose intolerance during postoperative hypertonic glucose administration was more dependent on the severity of the reduced hepatic mitochondrial redox state, as reflected by the blood ketone body ratio, than on the size of the liver remnant. (2) Insulin resistance developed when the redox state of the liver mitochondria was severely reduced. (3) It was very difficult to maintain the blood glucose level within normal range when the redox state was severely reduced. In patients, insufficient glucose administration can easily result in hypoglycemia, and excess administration can result in hyperglycemia, which might, in turn, result in hyperglycemic hyperosmolar nonketotic dehydration.
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