From the Guidelines
You should not hold your Toujeo (insulin glargine) before liver dialysis, but instead consult with your healthcare provider to adjust the dosing as needed, as insulin has no restrictions for use in patients with liver impairment and is indeed the preferred choice in those with advanced disease. Generally, insulin dosing may need adjustment before dialysis procedures, as dialysis can affect blood glucose levels and insulin metabolism 1. Your doctor might recommend reducing your Toujeo dose or temporarily switching to a different insulin regimen around your dialysis sessions. This is because liver dialysis (such as MARS or Prometheus) can impact how your body processes insulin and may increase the risk of hypoglycemia during or after the procedure. The timing matters too - if your dialysis is scheduled shortly after your usual Toujeo injection time, the risk of insulin-related complications may be higher. Some key points to consider include:
- Insulin therapy is the only evidence-based option for treating type 2 diabetes in patients with decompensated cirrhosis 1
- Optimal fasting blood glucose levels should not exceed 10 mmol/L to avoid hyperglycaemic complications 1
- Patients with liver disease should be screened for diabetes given its high prevalence in this population 1 Your specific medical situation, including your baseline glucose control, liver function, and other medications, will influence this decision. Keep glucose monitoring supplies available before, during, and after dialysis to check for low blood sugar, and make sure the dialysis team is aware of your diabetes management plan.
From the Research
Insulin Therapy and Liver Dialysis
- There is no direct evidence in the provided studies to suggest that Toujeo (insulin glargine) should be held before liver dialysis 2, 3, 4, 5, 6.
- However, it is known that insulin glargine can simulate normal basal insulin secretion and has been used to improve glycemic control in patients with type 2 diabetes on hemodialysis 3.
- The decision to hold or continue insulin therapy before liver dialysis should be made on a case-by-case basis, taking into account the individual's specific medical condition, glycemic control, and other factors.
- It is essential to consult with a healthcare professional for personalized advice on managing insulin therapy during liver dialysis.
Glycemic Control and Insulin Therapy
- Intensive glycemic control has been shown to have no meaningful benefit for microvascular and macrovascular outcomes in patients with type 2 diabetes, except for reduced rates of non-fatal myocardial infarction 4.
- Insulin glargine has been found to improve glycemic control and quality of life in type 2 diabetic patients on hemodialysis 3.
- Liraglutide or insulin glargine treatments have been shown to improve hepatic fat in obese patients with type 2 diabetes and nonalcoholic fatty liver disease 5.
Blood Glucose Monitoring
- Blood glucose monitoring is essential in diabetes care and management, and can help achieve maximum benefit for the patient and diabetes care team 6.
- Self-monitoring of blood glucose in people with type 2 diabetes can help identify patterns and trends in blood glucose control and inform treatment decisions 6.