Definition: Liver is an important organ of glucose metabolism, when its function is impaired by various liver diseases, it often affects normal glucose metabolism, and even develops hypoglycemia or diabetes mellitus, this kind of diabetes mellitus secondary to chronic liver parenchymal damage is collectively called hepatogenic diabetes mellitus. This kind of diabetes mellitus secondary to chronic liver parenchymal damage is called hepatogenic diabetes mellitus. In addition to drugs, the treatment of diabetes mellitus has progressed to pancreatic transplantation, islet cell transplantation, islet cell transplantation with artificial capillary devices, and liver transplantation for severe hepatitis and liver cirrhosis. Whether these are suitable for diabetes of hepatic origin and a series of problems after transplantation are still under study. Various liver diseases cause damage to the liver parenchyma and induce disorders of glucose metabolism, with clinical manifestations characterized by hyperglycemia and reduced glucose tolerance. This kind of diabetes secondary to liver parenchymal damage is called hepatic diabetes, which belongs to type II diabetes but is different from it. Its etiology has not been completely elucidated, and it is not yet curable. The treatment should take into account both liver damage and diabetes, and the principle is to treat the primary liver disease while keeping the blood sugar under control through modern comprehensive treatment. Therefore, doctors should clarify the treatment purpose of hepatogenic diabetes mellitus and the attainment standard of lowering blood glucose according to the characteristics of hepatogenic diabetes mellitus in order to carry out comprehensive treatment in a reasonable way. II. Characteristics and treatment purpose of hepatogenic diabetes mellitus The pathogenesis of hepatogenic diabetes mellitus is mainly insulin resistance, and with the development of the disease there can also be a relative lack of insulin secretion; hyperinsulinemia with decreased endogenous insulin sensitivity. Glucose tolerance test (OGTT) is reduced and its curve pattern is high, showing peak, high slope or convergence type; insulin release test, peak response is predominant; C-peptide release test is normal and C-peptide/insulin ratio is significantly reduced. The clinical manifestations are either recessive or dominant, and the symptoms vary in severity, but the typical symptoms of “three more” are not obvious and are often masked by the symptoms of chronic liver disease, and complications such as ketoacidosis rarely occur. The purpose of treatment for hepatogenic diabetes is to improve and protect liver function, reduce hyperglycemia and alleviate symptoms; correct lipid metabolism disorders and other metabolic disorders; prevent the occurrence and development of liver disease and various acute and chronic complications of diabetes and reduce mortality; through education, enable patients to master the ability of self-monitoring and self-care to ensure that the treatment meets the standards. The standards of glucose-lowering treatment for diabetes of hepatic origin: postprandial glucose 6.7-9.0 mmoL/L; 2 h postprandial glucose 6.7-12.0 mmoL/L; glycosylated hemoglobin 7.0-9.0%. The control criteria of glucose-lowering treatment for diabetes of hepatic origin. 1 Good control is the ideal indicator, which should be different from individual to individual, and it is not necessary to achieve it in elderly hepatogenic diabetes. The treatment status of hepatogenic diabetes mellitus has reached a new height. 1. Active and reasonable treatment of liver disease, by repairing liver cells, improving liver function, and restoring the number of hepatocyte membrane receptors and the ability of receptor binding; 2. Education of hepatogenic diabetes mellitus. Hepatogenic diabetes is a systemic disease, and adhering to rational treatment is a long-term, meticulous and arduous process that requires the cooperation of doctors, patients and their families. The purpose of education is to give patients a preliminary understanding of the basic knowledge and characteristics of hepatogenic diabetes, as well as diet, medication, self-monitoring and care, and to make them aware of the lifelong and long-term nature of treatment, so that they can actively cooperate to achieve the best treatment effect; 3. Diet Treatment. Diet therapy is one of the basic therapies for diabetes. Regardless of the type of diabetes, proper control of diet can reduce the burden on pancreatic islet b cells, which is beneficial to disease control. Even for diabetic patients who need medication, if diet is neglected, it is difficult to rely on medication alone. Since the 1980s, the dietary structure of diabetes has changed to a high carbohydrate, low fat, low protein, high fiber diet, in which carbohydrate accounts for 55-65% of total calories, fat accounts for 20-30% of total calories, mainly unsaturated fatty acids, protein accounts for 10-15% of total calories, and total dietary fiber accounts for 40-15% of total calories per day. The total amount of dietary fiber is 40-60g per day, cholesterol content is 300mg per day, salt is 6g per day, and the diet rich in vitamins and trace elements is encouraged to be easy to digest. Total daily dietary calories should be determined according to the patient’s weight, age, gender, presence of complications, nature of work and labor intensity. The principles of dietary treatment for hepatogenic diabetes are similar to those for primary diabetes, except that attention should be paid to both liver disease and diabetes, for example, for cirrhotic patients with esophageal varices, attention should be paid to the intake of appropriate high-fiber diets, and for patients with hepatic encephalopathy, the intake of protein should be restricted. Exercise therapy is also one of the basic treatments for diabetes mellitus, but hepatogenic diabetes mellitus is often limited by the presence of liver cell damage and abnormal liver function. In general, moderate activities of daily living are encouraged, but the duration of activities should not be too long and should be started after 30 min after meals, and after 2 h after meals, relative silence should be maintained. In patients with mild to moderate chronic hepatitis, especially those who are obese and have normal liver function, moderate exercise can be performed. As with primary diabetes, an exercise prescription should be developed, i.e., an exercise program based on the patient’s physical strength and endurance and liver function, including the type of exercise, amount of exercise, and precautions. The benefits not only lower blood glucose but also improve mental status and quality of life. IV. Treatment of hepatogenic diabetes Insulin has been used in clinical practice for 90 years since 1922. In recent decades, due to the introduction of human insulin and insulin analogues, as well as the continuous improvement of injection technology and drug delivery methods, the application of insulin has entered a whole new era. In the 1970s and 1980s, human insulin was successfully synthesized, one is semi-synthetic human insulin, which is obtained by converting alanine to threonine at position 30 on the B chain of porcine insulin and other raw materials. The other is the use of recombinant engineering biosynthesis of human insulin, the advantages of human insulin: 1, immunogenicity is greatly reduced, the generation rate of insulin antibodies is less than 30%, so there are fewer allergic reactions and other side effects; 2, strong potency, the corresponding dose of hypoglycemic effect than animal insulin enhanced by about 30%; 3, subcutaneous injection is absorbed quickly, but the effect is shorter than that of animal insulin. At present, the route of insulin administration and injection methods have been greatly reformed, and can be given in various ways, such as anal bolus, intraperitoneal administration, nasal inhalation and pulmonary inhalation, etc., but they are not routinely used because of irritation and irregular absorption. 1970s since the development of oral insulin, liposomal film coating to prevent destruction in the stomach, but because of irregular absorption and individual differences, it is difficult to predict the effective blood concentration and hypoglycemic effect. However, it is not used clinically at present because of regular absorption, individual differences and difficulty in predicting effective blood concentration and hypoglycemic effect. The most widely used injection method is subcutaneous injection, but the injection tools have been greatly improved, such as disposable syringes, insulin pumps and insulin pens, with insulin pens being the most simple and practical, and pressure spray syringes have been developed in recent years, which are not only absorbed quickly, but also avoid the pain of conventional injection, but have not yet been popularly used. In the application of insulin and the choice of preparations, the current use of insulin indications for type II diabetes tends to be positive attitude, using a variety of short-acting plus medium- or long-acting combination of injection programs, especially intensive treatment program is often used clinically, and now it is believed that intensive treatment is important for the prevention and treatment of various chronic complications of diabetes, and is respected by clinical use. The disadvantage of premixed formulations, although convenient, is that the respective doses cannot be adjusted separately. In cirrhosis, liver glycogen storage decreases, and hypoglycemia at night, it is more reasonable to inject short-acting type insulin before each column. In China, hepatogenic diabetes mellitus is mostly secondary to chronic hepatitis and cirrhosis, and although the plasma insulin level is elevated, the clinical use of insulin is still effective, and it is presumed that such patients have low biological activity of insulin and still need exogenous insulin. These patients have varying degrees of liver damage, and early use of insulin without oral hypoglycemic agents is generally recommended. In milder cases, dietary therapy and oral a-glucosidase can suppress blood glucose better. Before using insulin, doctors should know the composition, source, duration of use and content of all types of insulin preparations. The patient’s diet must also be regular and quantitative, and close monitoring of blood glucose during treatment must be meticulous, including the patient’s self-measurement of blood glucose, because the insulin dose should be adjusted at any time according to the measured blood glucose changes. The principle of dose use follows from small to large. The amount of insulin exceeds 200u per day, which indicates that insulin antibodies are generated in the body, and the antibodies usually appear in 3-4wk of treatment, and gradually increase with time, and the higher the dose, the easier it is to generate antibodies. Pay attention to the conversion of oral hypoglycemic drugs to insulin, there is no uniform conversion dose between the two dosages for reference. In recent years, some insulin analogues have been introduced. 1992, Eli Lilly and Company successfully manufactured human insulin analogues called Lyspro by recombinant technology, which has the same biological activity as human insulin, also in short-acting and long-acting preparations, its practical value needs further observation. Animal experiments also proved that C peptide has blood glucose regulating effect, C peptide is also called linker peptide, which is a fragment produced by the cleavage of insulinogen in the process of forming insulin, and it was thought to have no biological activity in the past. Now it is believed that it lowers blood glucose and has a synergistic effect on insulin regulation of blood glucose. Its hypoglycemic effect is not fully elucidated, but it does not depend on insulin receptor and tyrosine stimulation, does not stimulate the secretion of glucose raising hormone, is not easily taken up by the liver, is slowly cleared in the blood, does not affect insulin tolerance, and has certain effects on improving microcirculation and dilating small blood vessels. The value of clinical application needs further study. In conclusion, the principle of glucose-lowering treatment for hepatogenic diabetes mellitus is to prohibit oral hypoglycemic drugs and use insulin as early as possible, which not only effectively lowers blood glucose, but also facilitates hepatocyte repair and liver function recovery. However, there are a very small number of refractory cases that are not treated with insulin. In addition to drugs, the treatment of diabetes has progressed to pancreatic transplantation, islet cell transplantation, islet cell transplantation with artificial capillary devices, and liver transplantation for severe hepatitis and cirrhosis, whether these are suitable for diabetes of hepatic origin and a series of problems after transplantation are yet to be studied.