Addressing Common Liver Issues in Diabetes: Connection and Risks

By Dr. Sanjiv Saigal in Gastroenterology, Hepatology & Endoscopy , Liver Transplant and Biliary Sciences

Apr 26 , 2024 | 1 min read

The relationship between diabetes mellitus and liver disease is complex and multifactorial, with each condition potentially exacerbating the other. Diabetes can increase the risk of developing non-alcoholic fatty liver disease (NAFLD), now named Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). On the other hand, liver disease, particularly advanced stages such as cirrhosis, can lead to insulin resistance and glucose intolerance, potentially resulting in diabetes. Cirrhosis can also affect the liver's ability to regulate glucose levels, leading to diabetes.

Diabetic patients face a higher incidence of liver disease compared to the general population. Fatty liver is heavily associated with insulin resistance, a marker of diabetes. As diabetes progresses, it leads to the accumulation of fat in the liver. The combination of diabetes, dyslipidemia, hypertension, and obesity is referred to as metabolic syndrome. More than half of these patients are likely to have fatty liver.

Simple fatty liver in people with diabetes can progress to inflammation and liver cell damage, leading to fibrosis (scarring) of the liver. Advanced fibrosis can progress to cirrhosis and sometimes liver cancer. Poorly controlled diabetes can hasten the progression of fatty liver and increase the risk of developing advanced liver disease. The combination of fatty liver disease and diabetes has a synergistic effect, accelerating the progression of liver damage.

Diagnosing liver disease in diabetics involves a combination of medical history, physical examination, lab tests, and imaging studies. Ultrasound is commonly used to diagnose fatty liver. Other imaging tests include Fibroscan, Computed Tomography (CT) Scan, Magnetic Resonance Imaging (MRI), and sometimes Liver Biopsy.

Some diabetic medications can contribute to liver dysfunction, but the risk varies depending on specific medication & the dose. Individuals with diabetes need to discuss their medication regimen with their healthcare provider.

In addition, patients with liver disease, especially those with cirrhosis, are more susceptible to developing diabetes due to insulin resistance, glucose dysregulation, inflammation, obesity and metabolic syndrome. Patients with both diabetes and liver disease need to take extra precautions, including regular medical checkups, nutritional considerations, exercise, weight management & alcohol avoidance. 

Diabetes patients should avoid alcohol consumption and consume a healthy diet rich in fruits, vegetables, lean proteins, healthy fats and whole grains, and limit consumption of processed foods, saturated fats, trans fats, and added sugars. Regular physical activity and avoiding gaining weight are paramount in keeping the liver healthy.