Diabetes Forecast - February 2012

Diabetes 101 | the liver

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insulin into the blood. Insulin is the
signal for the body to absorb glucose
from the blood. Most cells just use the
glucose to supply them with energy.

doesn’t notice the insulin that’s there, the liver assumes that the body needs more glucose, even if blood glucose levels are already elevated. That is why people with diabetes can have sky-high blood glucose even if they haven’t eaten—for example, first thing in the morning. The liver is also responsible for the dangerously high blood glucose levels in people with diabetic ketoacidosis, a condition in which there is such a severe shortage of insulin that the body can’t process glucose as energy. Instead, it uses fats. Ketones, waste products created when the liver breaks down fat, can be toxic in large quantities.

Fat Facts

Processing the body’s fat is a key job for the liver. Once the liver is full of glycogen, it starts turning the glucose it absorbs from the blood into fatty acids, for long-term storage as body fat. The fatty acids and cholesterol are gathered as fatty packages and delivered around the body via the blood. Much of the fat ends up stored in fat tissues.

All of this extra fat produced and stored by the liver can sometimes lead the liver itself to get fat. In a condition known as nonalcoholic fatty liver disease, found in people who aren’t heavy drinkers (who have their own liver problems), liver cells accumulate excess fat instead of sending it off to fat cells. This disease is common, affecting 20 percent of adults overall and the majority of people with obesity or diabetes, or both. Doctors may test your blood to determine whether you have an ailing liver. In some cases, they may use an imaging technique or a biopsy to detect disease.

For most people, fatty liver doesn’t
cause any symptoms. But when it
does cause problems, the prognosis
can be serious. Severe cases may end
in cirrhosis, which is characterized
by scarring and poor liver function.
Cirrhosis can be fatal or may require
a liver transplant.

Save the Liver

Because of the links between diabetes and liver disease, people with diabetes and their health care providers have reason to focus on liver health and use tools such as a liver function test. Overweight people, particularly those who carry their extra weight around the middle, have the highest risk for liver problems and need to be extra diligent. There is no standard approach for the treatment of fatty liver, though there are medications in development. Typically, a doctor is likely to recommend losing weight, eating well, and exercising. These steps also help control blood glucose levels, of course, so what you do for your blood sugars is good for your liver, too.