The Liver Disease-Related Hypoglycemia: An Overview of the Impact, Management Approaches, and Underlying Mechanisms.

Abstract

Hypoglycemia in liver disease is a clinically significant yet underrecognized complication that severely impacts patient health and quality of life. Growing evidence highlights the liver's central role in glucose homeostasis, with dysfunction leading to hypoglycemia through impaired gluconeogenesis, insulin/glucagon dysregulation, and malnutrition. This review compiles disease-specific mechanisms (e.g., cirrhosis vs. acute liver failure) and their clinical implications, revealing that hypoglycemia risk correlates with liver disease severity, comorbidities, and therapeutic regimens. While current strategies emphasize tailored nutrition, careful pharmacotherapy, and continuous glucose monitoring (CGM), critical gaps persist in early diagnosis and personalized management. This work provides clinicians with a practical framework for hypoglycemia risk stratification, integrating (1) liver disease stage-specific monitoring protocols, (2) malnutrition correction strategies, and (3) insulin dose adjustment guidelines to alleviate iatrogenic hypoglycemia. Future directions include validating a liver-specific CGM algorithm optimized for cirrhosis, developing targeted therapies, and conducting multicenter trials to evaluate structured hypoglycemia prevention protocols in advanced liver disease. By bridging mechanistic insights with actionable care pathways, this review aims to reduce hypoglycemia-related morbidity in this vulnerable population.