Managing diabetes mellitus in patients with liver cirrhosis requires a tailored approach due to the complex interaction between these conditions. Lifestyle modifications, including dietary adjustments and exercise, are foundational. Pharmacological treatment, cautiously chosen to avoid hepatotoxicity, may include metformin for mild to moderate cases, while insulin therapy becomes necessary in advanced cirrhosis or when oral agents are contraindicated. Close glucose monitoring and collaborative care involving specialists are crucial to optimize management and prevent complications in this challenging patient population.