Diabetes and the Liver

One could wonder why in diabetes, a condition in which the blood sugar concentration in the blood goes up, need we worry about the liver? Or for that matter, even take the blood sugar reports seriously at all.

Doctors have begun to realise that the elevated blood sugar value is only the tip of the iceberg. Patients with type 2 diabetes, the common form of the disease that occurs in adulthood, often go on to develop problems with several other organs of the body, such as kidneys, brain, blood vessels, heart, feet and the liver.

At the root of the problem in Type 2 Diabetes, is the observation that contrary to intuitive logic, the blood levels of insulin in this condition is increased!

Insulin resistance (IR) as its is called brings with it several changes in the body such as thickening of the basement membrane, the floor on which cells of all organs of the body are lined up and pushes up fatty acids in blood circulation, that then gets deposited in the liver and blood vessels.

Fatty liver is seen in two-third of diabetics. It usually has no clear symptoms in the early stages often getting recognised during investigations for abnormal readings on liver function tests (AST, ALT or GGT levels in blood) or during an ultrasound examination.

It is however not an innocuous condition. Research shows that patients with extra fat in their livers die earlier, that is, their lives are shorter than their fat-free counterparts.

What happens to people with Fatty Liver? Some of them go on to develop a state of weakness of the liver called Liver Cirrhosis. In this condition, liver cells die insidiously and are replaced by scar tissue. The organ gradually starts functioning poorly, sometimes causing swelling of feet or retention of water in the abdomen. The veins in the food pipe can get engorged and rupture, causing blood vomiting.

When the liver gets very weak due to Liver Cirrhosis, transplantation of the diseased organ is sometimes required. This condition is getting so common that it makes up around a third of all causes of liver transplantation.

Another recent finding that research has shown up is that patients with diabetes and fatty liver are at increased risk of developing liver cancer. They often come silently or are incidentally picked up on imaging tests, but progress aggressively over few months. Scientists are debating whether all type 2 diabetics with excess fat in their liver should be monitored periodically with CT scans or MRI scans to watch for early liver cancer.

Diabetes therefore is a condition of not merely increased blood levels of sugar. Although it has a genetic basis, its severity and outcome is decided by how we eat, and exercise, and get our periodic checks done to ensure our organs are keeping healthy.

Liver is a large organ with lots of reserve, but it is wise not to ignore it in diabetes.