Sugar Matters
August 5, 2014
Diabetes and your liver

Of all the places diabetes can affect, the liver seems to be one of the most unlikely. Everyone has heard about alcohol affecting your liver, right? And of course there is always some article in the news about a medication causing liver damage – we all sit up and read that, then shake our heads at how much medicine can do us harm. You KNOW you have made the comment, don’t try to deny it.{{more}} The funny thing is that while we sit around saying how terrible it is for medications to cause liver damage (and I agree it is terrible), we do not realize that those high blood sugars can also damage your little old liver. True, no lie.

Quite often I receive laboratory tests results on a patient and I realize they have some liver damage. After we check a few things, we sometimes end up getting an ultrasound of the liver where the radiologist rubs a probe over your belly and takes pictures of your liver through the skin. Almost always, without another major problem like a hepatitis infection, we find the same diagnosis: fatty liver disease.

Non-alcoholic fatty liver disease, and a relative called non-alcoholic steatohepatitis (NASH) can be related to diabetes, especially poorly controlled Type 2 diabetes. These two diseases are specifically in people who DO NOT drink a lot of alcohol. If you do drink a lot of rum etc, you likely have a different form of liver disease. We have paid more attention to these diagnoses of fatty liver and NASH during the past 15 years or so. Without getting too much into detail, these diseases basically involve actual fatty deposits in the liver. In the case of fatty liver disease, the fat may not be damaging per se, but only time will tell. A great number of people have NASH, in which case the fatty liver IS undergoing some damage slowly. There is no telling how fast it may progress. But there is a good chance it will do so – in fact, NASH is one of the leading causes of liver cirrhosis and failure in the United States. It is more common in people who are overweight or have diabetes, and having high cholesterol also puts you at risk for NASH.

Now the interesting thing about this is that often fatty liver disease and NASH cause no symptoms. That’s right, you feel fine. The abnormal liver is usually found by accident on lab tests. Great, you say, so why should I care? You, in fact, should care a great deal because of the risk of liver damage in future, of which you will have symptoms. Liver damage can progress to liver failure. When this little organ does not work well, your entire body and health are affected more than you can imagine. Want a picture of liver failure? Picture this: big belly full of fluid, bony legs and arms, skin that bruises all the time, muscles that disappear, yellow eyes. Not pretty, is it?

What can you do to prevent fatty liver disease and NASH?

Control those blood sugars.

Get your cholesterol under control also.

Avoid excessive amounts of alcohol. Yes, two drinks ARE enough for tonight…

Stay active and exercise.

Anita Ramsetty, MD

Medical Director Endocrine Care Group

Tel: 843-798-4227