Diabetes and Your Liver

Your liver is the largest organ in your body. You need it remove waste, digest fat, break down substances, and balance your blood sugar. Liver disease is on the rise. Diabetes and liver disease are often linked. Each increases the risk for the other.

Metabolism is how your body turns food and drink into energy to keep you alive and working. Metabolic dysfunction occurs when this process fails. It causes the body to be out of balance. For example, it can cause blood sugar to be too high. When blood sugar levels are high over a long time, this can damage internal organs. This includes your liver. At the same time, a buildup of fat and damage in the liver can increase your blood sugar levels. This increases the risk of developing diabetes. 
What are the types of liver disease? 

• Metabolic dysfunction-associated steatotic liver disease (MASLD)
  • This early-stage disease occurs when excess fat builds up in your liver. 
• Metabolic dysfunction-associated steatohepatitis (MASH)
  • A more severe form of MASLD where inflammation results in development of scar tissue. 
• Cirrhosis
  • This late-stage disease involves scarring and permanent damage to your liver. 
• Hepatocellular carcinoma (HCC)
  • Most common type of liver cancer.
• Acute liver failure
  • Liver is no longer functional.

People whose diabetes is poorly controlled are at the greatest risk for the progression of liver disease.
Liver disease and diabetes share many of the same risk factors. These include:

• Age
• Obesity
• Smoking
• High blood pressure
• High cholesterol

Are there symptoms?
MASLD and MASH usually do not have any signs or symptoms. They can take many years to develop. Once liver disease progresses, symptoms may include:

•  Loss of appetite
• Tiredness
• Yellowing of skin or eyes
• Right-sided belly pain
• Weight loss (without trying)

People with diabetes should talk with their healthcare provider about screening for liver disease. The Fibrosis-4 (FIB-4) Index is calculated using simple lab tests and your age. With higher FIB-4 scores, your provider may order more tests like ultrasound, CT scans, MRI or even liver biopsy.

Preventing and Treating Liver Disease
Many of the same lifestyle changes that help manage diabetes also help with both preventing and treating liver disease. 

• Losing weight
  • 5-10% weight loss can help reduce fat in your liver and improve blood sugar
• Healthy diet
  • Extra carbohydrates lead to higher blood sugar levels, and they are stored in the liver. So, limiting sweets and balancing carbohydrates is important. Limiting saturated fat is also helpful.
• Physical activity
  • Moderate physical activity (like walking) can improve the way your body uses blood sugar. It can also reduce the fat stored in the liver. A common goal is to be active for about 30 minutes, 5 days per week. 
• Limiting alcohol
  • This can reduce stress on the liver and slow the damage.

In addition to lifestyle changes, other treatments for liver disease can include:

• Improving A1C levels with diabetes medications
• Two medications that can slow progression of MASH:
  • Actos (pioglitazone)
  • Rezdiffra (resmetirom)
• Weight loss medications
• Bariatric surgery

Questions? Talk with your healthcare provider about your risk of developing liver disease.