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Insulin requirements can be high in patients with compensated cirrhosis, whereas they can be low in decompensated patients due to a reduction in hepatic clearance and gluconeogenesis.84 Because of this, it is recommended that the administration of insulin in patients with cirrhosis should start with close monitoring due to the risk of hypoglycemia.85 The pharmacokinetic of short-acting insulin analogues such as insulin lispro, aspart and glulisine is not significantly altered as a result of hepatic dysfunction

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Nature 385 , 165168 (1997)