Managing the Risk of Liver Disease With Diabetes

Diabetes and Liver Disease

Liver diseases are often associated with diabetes. In fact, diabetes is now considered the most common cause of liver disease in the US. Liver disease is a potentially deadly complication of diabetes, so it’s important to be aware of the symptoms, and how to prevent liver damage.

What Kind of Liver Problems Occur in Diabetics?

Many conditions affecting the liver are found in diabetics. Cirrhosis associated with diabetes is one of the most common problems and accounts for 4.4% of diabetes-related deaths.

Other liver diseases found in type 2 diabetics include:

• Abnormal liver enzymes – This means the levels or some liver enzymes are abnormally high. For example, the enzyme ALT is rarely raised in a healthy population (only in 0.5% of cases), while is found elevated in up to 24% of diabetics. Elevated enzymes like ALT and AST may not cause any symptoms; however, the majority of people who have these enzymes high are also suffering from liver diseases such as fatty liver and chronic hepatitis.
• Fatty liver disease – This is a condition where the liver becomes infiltrated with fat. The prevalence of fatty liver disease is between 34 and 74% in diabetics, and found in almost 100% of the cases of diabetes associated with obesity. A long time ago this condition was considered benign, but recent studies show that it increases the risk of cirrhosis and liver cancer.
• Cirrhosis – This is a progressive disease where the healthy liver tissue is replaced by scar tissue, preventing it from functioning properly. As a result, the liver process nutrients, hormones, drugs and naturally produced toxins slower. The production of proteins and other chemicals made in the liver are affected as well.
• Liver cancer – Hepatocellular carcinoma, a form of liver cancer, occurs four times more frequently in diabetics compared with people with no diabetes.
• Acute liver failure – Acute liver failure happens when the liver loses its function rapidly (over days or weeks), This can lead with serious complications (i.e. excessive bleeding, increased pressure in the brain), and is a medical emergency.
• Hepatitis C – There is also an increased risk of hepatitis C, although scientists do not understand exactly why.

Simply put, a person with diabetes is more likely to have liver disease, and the opposite is also true: people with liver diseases have a high prevalence of diabetes.

Preventing and Managing Liver Disease

1. Review your anti-diabetes medication with your doctor, as some drugs can also alter the liver function and cause liver diseases (including acute liver failure). Your doctor may recommend an alternative drug, or make other changes in your treatment plan. Arrange regular follow up appointments to your doctor to assess the function of your liver.
2. Lifestyle changes are also important. If you need to lose weight, see a dietician and aim for losing no more than 1-1.5 kg/week. Low-fat diets should be avoided (especially if you suffer from fatty liver disease), while the Mediterranean diet appears beneficial. Avoid alcohol, because is toxic for the liver and can also interfere with your medication.
3. Stay active, and try to exercise daily. Exercise helps improve insulin sensitivity, and abnormal insulin sensitivity is involved in the development of some liver conditions.