How should insulin degludec be used and dosed in diabetic patients with hepatic impairment (Child‑Pugh A‑C) and what monitoring is required?

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Last updated: February 18, 2026 • View editorial policy

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A patient on insulin degludec 8 units, NPH 28 units, and a carbohydrate‑to‑insulin ratio of 1 unit per 6 g has blood glucose values of 134 mg/dL at 8 am, 177 mg/dL at noon, 198 mg/dL at 5 pm, 270 mg/dL at 9 pm, and 100 mg/dL at 2 am. If the degludec dose will be reduced to 6 units today, what should the NPH dose be and what carbohydrate‑to‑insulin ratio should be used?

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