People with
type 2 diabetes mellitus (T2DM) have a higher
risk of developing chronic
liver disease (CLD) and its
complications. T2DM,
obesity, and
insulin resistance are all strongly associated with
nonalcoholic fatty liver disease (
NAFLD). Conversely, people suffering from
cirrhosis have reduced
glucose tolerance in approximately 60% of cases, diabetes in 20% of cases, and
insulin-mediated
glucose clearance is lowered by 50% as compared with those
who do not have
cirrhosis. An exploratory
review was conducted using existing published evidence from clinical studies on dosing and titrations of individual
insulin formulations in people with CLD to optimize
insulin dosage titration for minimizing
hypoglycemia risk. This article discusses current
hyperglycemia treatment techniques for
patients with CLD as well as the
consensus recommendations on
insulin use in special
populations with T2DM and hepatic impairment. Based on available evidence and expert diabetologists’ recommendations, careful
insulin dose titration, customized glycemic targets, and frequent
glucose screening are recommended for optimal glycemic management without
hypoglycemia in CLD.
Long-acting insulin should be avoided or used when
short-acting insulin fails to provide adequate
glycemic control with raised
fasting blood sugar levels. While the
patient’s
glucose profile is being evaluated, the prandial
insulin dose can be lowered by 25% initially. The
dose can be titrated based on the
patient’s postprandial glycemic expression and whether their
food intake meets the
Child–Pugh scores A and B categories. Titrating premixed
insulins is difficult for
patients in class C since their
appetite and
overall health are constantly compromised and in flux.