Liver disease and diabetes are tightly linked with patients with diabetes at a higher risk of developing liver disease and those with liver disease are at higher risk of diabetes. Nearly all forms of liver disease occur in diabetic patients. Abnormal liver enzymes, nonalcoholic fatty lives disease (NAFLD), cirrhosis, hepatocellular carcinoma, and acute liver failure all occur in diabetes patients as well as an unknown link between diabetes and hepatitis C. Liver disease is a significant cause of death amongst diabetics, accounting for 12.5% of diabetes-related deaths.
Cirrhosis of the liver is a significant cause of death in diabetics, particularly those who use insulin. However, the pathogenesis of cirrhosis is still unknown. Cirrhosis is known to be a precursor to hepatocellular carcinoma. Studies show that people with hepatitis C are more likely to develop diabetes and are likely to redevelop hepatitis C and diabetes after transplant, suggesting that hepatitis C is pathogenic. Elevated levels of the liver enzyme alanine aminotranferase (ALT) occur at an incidence of 2-24% in type 2 diabetes while high levels of aparate aminotranferase (AST) are also more common in diabetics. In a study of liver enzymes and diabetes, 98% of subjects with high ALT and AST had liver disease, most commonly NAFLD.
Fatty Liver Disease and Diabetes
Diabetes raises the risk of developing nonalcoholic NAFLD, which is a build-up of excess fat in the liver. NFLD is the most common chronic disease in the U.S. Fatty liver disease occurs in at least half of all type 2 diabetes patients and nearly half of type 1 patients. Of the obese diabetic population NFLD affects virtually 100% of individuals. Other complications of diabetes such as high cholesterol, and high blood pressure increase the risk of developing liver disease. There are no symptoms of fatty liver disease however its progression is much like that of alcoholic liver disease and can lead to inflammation of the liver, cirrhosis, liver cancer and heart disease.
Treatment for Liver Disease and Diabetes
Preventative measures against liver disease and diabetes include losing weight, reducing high blood pressure, keeping LDL cholesterol and triglycerides in check, controlling blood glucose levels, and avoiding alcohol. It has also been found that more than 50% of diabetics who develop liver disease are malnourished. While low-carb, low-glycemic index diets are fine, low-fat diets should be avoided. Instead a Mediterranean diet with high monounsaturated fats, complex carbohydrates, and small amounts of red wine and red meat has been suggested particularly for people with NAFLD. Drug treatment for liver disease can become complicated due to the possibility of drug interactions, altered drug metabolism due to liver damage, and the risk of hepatoxicity.
