INS and Hyperglycemia: Cardiometabolic consequences of cirrhosis due to hepatic insufficiency include impaired glucose metabolism (hyperglycemia due to reduced catabolism of glucagon and growth hormone) and increased IR, followed, in later stages, by hypoglycemia due to decreased insulin catabolism and reduced gluconeogenesis/glycogenolysis163, altered protein metabolism (hypoalbuminemia and ascites, loss of muscle proteins)164, and lipid metabolism (hypocholesterolemia165 with alterations of cell membranes, and lipids malabsorption due to reduced bile acid synthesis166.