Diabetes and the liver

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Diabetes and the liver

It is a well known fact in the Medical world that diabetes may be associated with various types of liver disease. The risk is higher in those that have had diabetes for more than ten years. The association between diabetes and liver disease falls into three categories; liver disease may follow the presence of diabetes, diabetes may occur as a consequence of liver disease and liver disease may occur coincidentally with diabetes. This treatise will focus on liver disease that is consequent upon diabetes and the treatment of diabetes. Diabetes can lead to a condition called fatty liver in which excessive amounts of fat accumulate in the liver. This fat accumulates due to the very high amounts of triglycerides in the blood. Triglycerides are formed when the fat that is in the food eaten is digested. High levels of triglycerides are commonly seen in people with diabetes whose blood sugar levels are poorly controlled. This can lead to

inflammation, hardening and scarring of the liver, which scarring can then lead to liver cirrhosis which is most commonly seen in people who abuse alcohol and people who are infected with Hepatitis B virus. Fatty liver is almost always not associated with symptoms except when there is associated inflammation of the liver and is mostly discovered when examinations or tests are carried out for other reasons. When symptoms are present, the individual starts to notice a mass in the upper right part of the abdomen. The term steatohepatitis means inflammation and damage to the cells of the liver due to fat accumulation. This condition is commoner in people with diabetes whose blood sugar level is poorly controlled. It can also occur in people with diabetes whose blood sugar level is well controlled. The tests that will be carried out to confirm this condition includes ultrasound of the abdomen and a test in which a long needle will be inserted into

the liver through the skin to remove a very little piece of the liver for laboratory analysis. This is often the best way to diagnose this condition.Treatment of this condition in people with diabetes entails ensuring good blood sugar control and gradual weight loss in those that are obese or overweight. Weight loss is the most effective treatment of this condition. The condition may in some people lead to progressive liver disease that will require liver transplantation.

Excess glucose in the blood is normally stored in the liver as a substance called Glycogen. Most patients with diabetes have this glycogen stored in their liver in excessive amounts. This can lead to liver enlargement, abdominal pain, nausea, vomiting and in some cases a condition called ascites in which the abdomen starts to be filled with fluid leading to massive enlargement of the abdomen. As blood sugar control improves, these abnormalities recede.Gall bladder disease can also be seen in people with diabetes, this manifests as gallstones, jaundice and generalized body itching. Liver disease may also develop as a side effect of some of the drugs used to treat diabetes. A drug commonly used in Nigeria to treat diabetes called Chlorpropamide may cause liver injury in some who use it and lead to the development of jaundice. The jaundice disappears when the drug is stopped. In the same vein, drugs called statins that are used to modify

cholesterol levels may as part of their side effects have some unsavoury effects on the liver, hence the need for the test called liver function test from time to time. An antidiabetic drug called Troglitazone was withdrawn from the market some years ago after it caused acute liver failure in some users.

The advice then for all with diabetes who are on various medications is that they should do close self monitoring and once they feel any symptom of ill health or feel any discomfort after using a drug they should quickly see their healthcare providers. Good blood sugar control, avoidance of excessive alcohol intake, maintenance of a healthy weight and reduction in intake of cholesterol containing foods are some of the ways to reduce the risk of development of liver disease in people with diabetes. A liver function test should also be carried out from time to time.

http://www.sunnewsonline.com/webpages/features/goodhealth/2010/jan/31/Diabetes-corner-31-01-2010.htm