PMID- 37354474
OWN - NLM
STAT- MEDLINE
DCOM- 20230630
LR  - 20230630
IS  - 0004-5772 (Print)
IS  - 0004-5772 (Linking)
VI  - 71
IP  - 2
DP  - 2023 Feb
TI  - Expert Opinion by Clinicians on the Use of Insulin Therapy in People with Hepatic 
      Impairment.
PG  - 11-12
LID - 10.5005/japi-11001-0171 [doi]
AB  - 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.pThis 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.
CI  - (c) Journal of the Association of Physicians of India 2011.
FAU - Chawla, Purvi
AU  - Chawla P
AD  - Consultant Diabetologist and Director- Clinical Research, Lina Diabetes Care, 
      Diabetes & Beyond, Mumbai Diabetes Research Centre, Mumbai, 
      Maharashtra;Corresponding Author.
FAU - Shunmugavelu, Minakshisundaram
AU  - Shunmugavelu M
AD  - Consultant Diabetologist, Trichy Diabetes Specialty Center, Tiruchirappalli, 
      Tamil Nadu.
FAU - Jaggi, Shalini
AU  - Jaggi S
AD  - Director and Consultant Diabetologist, Lifecare Diabetes Centre, New Delhi, 
      Delhi.
FAU - Asirvatham, Arthur J
AU  - Asirvatham AJ
AD  - Consultant Diabetologist, Arthur Asirvatham Hospital, Madurai, Tamil Nadu.
FAU - Basu, Debasis
AU  - Basu D
AD  - Medical Director, Healious Global Private Limited, Kolkata, West Bengal; 
      6Consultant Diabetologist, IVA Speciality Clinic & Diabetes Care Centre, 
      Mumbai, Maharashtra.
FAU - Shah, Tejas
AU  - Shah T
AD  - Diabetologist, IVA Speciality Clinic & Diabetes Care Centre, Mumbai, 
      Maharashtra.
FAU - Farishta, Faraz
AU  - Farishta F
AD  - Consultant Endocrinologist, FS Endocrinology & Diabetic Center, Hyderabad, 
      Telangana.
FAU - Das, Ashok Kumar
AU  - Das AK
AD  - Consultant Endocrinologist, Pondicherry Institute of Medical Sciences, 
      Puducherry, India.
LA  - eng
PT  - Journal Article
PL  - India
TA  - J Assoc Physicians India
JT  - The Journal of the Association of Physicians of India
JID - 7505585
RN  - 0 (Blood Glucose)
RN  - IY9XDZ35W2 (Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Insulins)
SB  - IM
MH  - Humans
MH  - Blood Glucose/metabolism
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy
MH  - Glucose
MH  - *Hypoglycemia/chemically induced
MH  - Hypoglycemic Agents
MH  - Insulin/therapeutic use
MH  - *Insulins/therapeutic use
MH  - *Liver Diseases
EDAT- 2023/06/24 21:05
MHDA- 2023/06/26 06:41
CRDT- 2023/06/24 13:11
PHST- 2023/06/26 06:41 [medline]
PHST- 2023/06/24 21:05 [pubmed]
PHST- 2023/06/24 13:11 [entrez]
AID - 10.5005/japi-11001-0171 [doi]
PST - ppublish
SO  - J Assoc Physicians India. 2023 Feb;71(2):11-12. doi: 10.5005/japi-11001-0171.