Five to eight out of 10 cirrhotic patients may have disorders of glucose metabolism, and two to three may have combined diabetes. Many cirrhotic patients do not believe this, they say they have checked their fasting blood sugar, every time is normal, they do not have ordinary diabetic patients drink more, eat more, urinate more, weight loss and other “three more and one less” symptoms. However, after the doctor persuaded the patient to go for a glucose tolerance test, the results showed that most of the patients had different degrees of glucose metabolism disorders, and some of them had developed more severe diabetes and had to be treated with insulin. Most of the patients with cirrhosis combined with glucose metabolism disorders do not have the typical symptoms of diabetes “three more, one less”, nor do they have a family history of diabetes, and their fasting glucose is normal for many times, but why are they diagnosed with diabetes now? Why is there such a high incidence of diabetes in patients with cirrhosis? Healthy liver can regulate blood sugar The liver is not only an important organ for the metabolism of proteins, fats and vitamins, but also an important place for glucose metabolism. After eating, the liver exerts its storage function to synthesize elevated blood glucose into liver glycogen for storage, while inhibiting the conversion of other energy substances into sugar, and blood glucose returns to normal levels. When fasting blood sugar is too low, the liver can again break down the liver glycogen in its storehouse into glucose and accelerate the conversion of other substances into sugar to maintain normal blood sugar. When the liver functions abnormally, hepatic glycogen synthesis is impaired and blood glucose cannot be converted into hepatic glycogen for storage, causing blood glucose to remain at high levels and causing diabetes. In addition, the liver is also the main target organ for various hormones related to glucose metabolism and an important site for degradation. The liver also converts sugars into lipids and non-essential amino acids, regulating the various needs of the body. Once the liver is damaged for various reasons, our normal glucose metabolism function will be implicated and abnormal, causing an increase in blood glucose and the development of diabetes. Early stage only postprandial blood glucose rise Usually in the early stage, the fasting blood glucose of patients with cirrhosis combined with abnormal glucose metabolism is normal, only the postprandial blood glucose rises to varying degrees, at this time, the only way to make a clear diagnosis is to carry out screening through glucose tolerance test. The glucose tolerance test is to let patients measure blood glucose at half-hour, one-hour, two-hour and three-hour intervals after fasting and eating standard amount of glucose powder, in order to know the blood glucose concentration at different time points. mmmol/L and fasting blood glucose over 6.1mmmol/L at any one time point can be diagnosed as diabetes mellitus. Since screening for abnormal glucose tolerance is not yet routinely practiced in clinical practice for patients with cirrhosis, it often leads to missed diagnoses. Some doctors often do not pay attention to abnormal glucose metabolism in cirrhosis, and often misuse drugs such as glucose and diuretics that aggravate glucose metabolism disorders and pancreatic β-cell burden, accelerating the progress of the disease. Some studies have found that patients with cirrhosis combined with diabetes mellitus have significant differences in clinical manifestations, regression, complications and mortality rates from those with ordinary diabetes mellitus. The life expectancy of cirrhotic patients with combined diabetes will be affected because the risk of liver cell failure is greatly increased in the hyperglycemic state, which can aggravate the disease. The combination of Chinese and Western intervention in advance Patients with cirrhosis should pay attention to their liver function changes while keeping an eye on their blood sugar, especially postprandial blood sugar. Specialists treating cirrhosis need to make early comprehensive interventions for patients with cirrhosis with abnormal glucose metabolism and review blood glucose regularly, avoiding high-dose intravenous infusion of glucose solution during treatment, and adding insulin to counteract the effect of glucose when necessary. The treatment of cirrhosis combined with abnormal glucose metabolism is very difficult, and most of the drugs commonly used in clinical treatment of diabetes are detrimental to liver function and not suitable for the treatment of cirrhosis combined with diabetes. For patients with cirrhosis combined with diabetes mellitus, insulin therapy is recommended in principle, but due to the impaired hepatic glycogen reserve, insulin injection is more prone to hypoglycemic reactions than in general diabetic patients. In view of the special characteristics of the treatment of cirrhosis combined with glucose metabolism abnormalities, we are carrying out a research project on the integrated treatment of cirrhosis combined with glucose metabolism abnormalities by Chinese and Western medicine. We will move the treatment of cirrhosis combined with diabetes to the stage of abnormal glucose tolerance, and combine Chinese and Western medicine to treat cirrhotic patients before they develop diabetes or in the early stage of diabetes, in order to reduce the chance of diabetes and delay the development of the disease. With the treatment of liver fibrosis as the focus, we start from improving liver function and give dietary guidance, so that patients can improve liver function and delay the progression of cirrhosis while correcting abnormal glucose metabolism, thus improving the quality of life and prolonging life.