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People with type 2 diabetes mellitus (T2DM) have a higher risk of developing chronic liver disease (CLD) and its complications. T2DM, obesity, and insulin resistance are all strongly associated with nonalcoholic fatty liver disease (NAFLD). Conversely, people suffering from cirrhosis have reduced glucose tolerance in approximately 60% of cases, diabetes in 20% of cases, and insulin-mediated glucose clearance is lowered by 50% as compared with those who do not have cirrhosis. An exploratory review was conducted using existing published evidence from clinical studies on dosing and titrations of individual insulin formulations in people with CLD to optimize insulin dosage titration for minimizing hypoglycemia risk. This article discusses current hyperglycemia treatment techniques for patients with CLD as well as the consensus recommendations on insulin use in special populations with T2DM and hepatic impairment. Based on available evidence and expert diabetologists’ recommendations, careful insulin dose titration, customized glycemic targets, and frequent glucose screening are recommended for optimal glycemic management without hypoglycemia in CLD. Long-acting insulin should be avoided or used when short-acting insulin fails to provide adequate glycemic control with raised fasting blood sugar levels. While the patient’s glucose profile is being evaluated, the prandial insulin dose can be lowered by 25% initially. The dose can be titrated based on the patient’s postprandial glycemic expression and whether their food intake meets the Child–Pugh scores A and B categories. Titrating premixed insulins is difficult for patients in class C since their appetite and overall health are constantly compromised and in flux.

Background: Temporal lobe epilepsy (TLE) is the most common cause of partial seizures. However, there is a paucity of data on the correlation of clinical and semiological features of TLE with specific imaging findings on magnetic resonance imaging (MRI). Objective: In this study, we sought to evaluate the association between the semiology of TLE with specific etiological findings as identified on MRI. Materials and methods: This was a single-center, observational study in which consecutive patients presenting with clinical features diagnostic of TLE underwent a brain MRI on a 1.5 T scanner. The data collected from the various MR parameters were then correlated with history. Results: A total of 90 patients were included in the study. The mean age of the study population was 29.1 years. Females comprised 45% of the study population. Mesial temporal sclerosis (MTS) was the most common imaging finding in about 60% of patients. Four out of five patients had aura whereas 70% had automatisms. The presence of aura in TLE patients was significantly associated with MTS on MRI (p = 0.042). The presence of automatism and history of childhood febrile seizure did not have a significant association with any specific etiological findings on MRI (p = 0.254 and 0.731, respectively). Drug-refractory epilepsy was commonly associated with the presence of MTS on MRI (p = 0.004). The presence of dual pathology on MRI was associated with drug-refractory epilepsy (p = 0.031). Conclusions: The presence of aura and drug-refractory epilepsy point towards the presence of MTS. Dual pathology, on MRI, in TLE patients may be a risk factor for drug-refractory epilepsy