Liver disease may occur as a result of diabetes, and the reverse is true as well. Non-alcoholic liver disease may also be caused by obesity, protein deficiency, HIV infection and exposure to toxic chemicals. Drugs such as corticosteroids, tamoxifen and estrogens also may damage the liver. Diabetics who have concurrent hepatitis C infection are at high risk of complications.
The liver plays a role in glucose regulation. Glucose is transported from the intestines to the liver, which stores it as glycogen or uses it for fuel. Insulin receptors in fat, liver, and muscle cells facilitate the use of glucose. Insulin regulates the entry of glucose into tissues and promotes glycogen storage. Insulin is metabolized in the liver, where it promotes the production of glycogen, protein, cholesterol, and triglycerides and stimulates the formation of low density lipoproteins, or LDL, which transport cholesterol into the arteries. In diabetes, excessive output of glucose by the liver contributes to elevated fasting blood sugars.
Fat accumulation in the liver may be linked to excess glycogen, which is common among diabetics. Fatty deposits may be due to the increased transport of fat to the liver from the intestines or to decreased removal of fat from the liver. The condition occurs secondary to obesity as well as diabetes, but the exact reasons are unknown. The National Institute of Diabetes and Digestive and Kidney Disease reports that 10 to 20 percent of Americans have fatty liver. Diagnosis may depend on blood work, CT scan or ultrasound imaging and biopsy.
Although there may be no symptoms, an enlarged liver and enzyme abnormalities are characteristic of fatty liver. The condition may also cause abdominal pain, nausea and vomiting, or--rarely--fluid accumulation around the liver. Symptoms are likely to improve with better blood sugar control.
Liver cells may become inflamed as a result of fatty deposition. Diabetic or nonalcoholic steatohepatitis is the medical term for this condition. NIDDK states that 2 to 5 percent of Americans have NASH. Without treatment, the condition may progress to scarring of liver tissue, or nonalcoholic cirrhosis.
Significance of Diabetic Medicines
Occasionally, oral medications used in the treatment of type 2 diabetes have unwanted effects on the liver. Metformin is contraindicated in persons with chronic liver disease because of the risk of lactic acidosis, a condition of lactate build up in the blood and tissues, which lowers the body pH. Glyburide is excreted in the bile and has been linked, although rarely, to chronic hepatitis. According to Drug Information Online, chlorpropamide may cause liver inflammation characterized by jaundice and itching, generally within the first two to five weeks of taking the medication.
Diabetic-related liver disease may be largely prevented. Careful control of blood sugar, maintenance of a healthy weight, and having regular check-ups to monitor the effects of medications can help reduce the risk of liver problems.