Usually, the level of circulating blood glucose is kept tightly regulated by an appropriate response by the beta cells of the pancreas to produce insulin.

In diabetes, there can often be a mismatch between administered insulin and blood glucose levels. There can also be problems with administered insulin action in diabetes if there are liver or kidney problems.

Liver impairment
If present, there can be a reduced capacity for gluconeogenesis which can reduce the amount of active glucose available for insulin to work with. Insulin dose reduction may be needed in this situation. This is also because liver impairment can reduce the metabolism of injected insulin, so it remains metabolically active for longer.