Diabetes and Liver Disease
Written by Carolien Koreneff, CDE-RN, FADEA
As a healthcare professional you will no doubt agree with me that the liver is not a very elegant looking organ. But, it plays a very important role in our bodies; without a liver we would die. People with diabetes, and in particular type 2 diabetes, have a higher risk of developing liver disease. Carolien Koreneff, a credentialled diabetes educator explores why and how.
The anatomy and role of the liver
The liver is a reddish-brown coloured organ, approximately the size of a football. It weighs around 1.5kg and is positioned just under the rib cage and diaphragm, on the right-hand side of the abdomen. The liver is made up of two large lobes and covers the gall bladder, parts of the pancreas and some of the intestines. It is the largest gland in in the human body.1
There are more than 500 vital functions that have been identified with the liver.
For example, the liver is responsible for the digestion of food and getting rid of toxic substances. Its main job is to filter the blood as it comes from the digestive tract and before it passes to the rest of the body. The liver metabolises medications and detoxifies other chemicals that have been absorbed into the blood. Additionally, it clears waste through the bile, which will end up in the intestines via the bile duct and leaves our body through our bowel movements.
Furthermore, the liver plays a role in blood clotting, carrying fats through the body and in the storage of vitamins and iron. Another important role of the liver, particularly when we talk about diabetes, is that the liver converts excess glucose into glycogen for storage and converts this glycogen back to glucose for energy as needed.
Long-term damage to the liver can lead to cirrhosis (scarring of the liver) which causes the liver to leak ascites (a type of fluid) into the belly. Cirrhosis can lead to liver failure, which is a life-threatening condition. However, early treatment can help prevent cirrhosis and liver failure.
Common causes of liver disease
Viruses and parasites can cause an infection in the liver, which can lead to inflammation and reduced liver function. The most common types of liver infection are: Hepatitis A, Hepatitis B and Hepatitis C.
Auto-immune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis are examples of auto-immune liver diseases, in which the immune system attacks the liver (similar to how the immune system attacks the pancreas in people with type 1 diabetes).
If gallstones become stuck in the bile duct the liver cannot drain properly. Blockages like these can lead to hepatitis and bile duct infection (cholangitis).
Abnormal genes inherited from one or both of your parents can cause liver damage through a build-up of various substances, such as a build-up of iron in haemochromatosis or a build-up of copper in Wilson’s disease.
Other common causes of liver disease include liver cancer, chronic alcohol abuse, and certain prescription medications, over the counter medications and herbal compounds.
Non-alcoholic fatty liver disease (NAFLD)
By Carolien Koreneff, CDE-RN, FADEA
As a healthcare professional you will no doubt agree with me that the liver is not a very elegant looking organ. But, it plays a very important role in our bodies; without a liver we would die. People with diabetes, and in particular type 2 diabetes, have a higher risk of developing liver disease. Carolien Koreneff, a credentialled diabetes educator explores why and how.
Anatomy
The liver is an organ, approximately the size of a football. It is a reddish-brown colour, weighing around 1.5kg. It is just under the rib cage and diaphragm, on the right-hand side of the abdomen. The liver consists of two large lobes, covering the gall bladder, parts of the pancreas and some of the intestines. It is the largest gland in in the human body.1
The liver carries out more than 500 vital functions.
For example, the liver is responsible for the digestion of food and getting rid of toxic substances. Its main job is to filter the blood as it comes from the digestive tract and before it passes to the rest of the body. The liver can also metabolise medications and detoxify other chemicals in the bloodstream. Another important function is it clears waste through the bile, which ends up in the intestines via the bile duct and leaves our body through our bowel movements.
Furthermore, the liver plays a role in blood clotting, carrying fats through the body and in the storage of vitamins and iron. Another important role of the liver, particularly when we talk about diabetes, is that the liver converts excess glucose into glycogen. Which is stored until the liver converts this glycogen back to glucose for energy as needed.
Long-term damage to the liver can lead to cirrhosis (scarring of the liver) which causes the liver to leak ascites (a type of fluid) into the belly. Cirrhosis can lead to liver failure, which is a life-threatening condition. However, early treatment can help prevent cirrhosis and liver failure.
Common causes of liver disease
Viruses and parasites can cause an infection in the liver, which can lead to inflammation and reduced liver function. The most common types of liver infection are: Hepatitis A, Hepatitis B and Hepatitis C.
Auto-immune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis are examples of auto-immune liver diseases, in which the immune system attacks the liver (similar to how the immune system attacks the pancreas in people with type 1 diabetes).
If gallstones become stuck in the bile duct the liver cannot drain properly. Blockages like these can lead to hepatitis and bile duct infection (cholangitis).
Abnormal genes inherited from one or both of your parents can cause liver damage. This can be through a build-up of various substances, such as a build-up of iron in haemochromatosis or a build-up of copper in Wilson’s disease.
Other common causes of liver disease include liver cancer, chronic alcohol abuse, and certain prescription medications, as well as over the counter medications and herbal compounds.
Non-alcoholic fatty liver disease (NAFLD)
Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease in adult Australians. Fatty Liver is often the laymen’s term. It is an asymptomatic condition in which excess fat builds up in the liver. Consequently, NAFLD increases the risk of liver inflammation, cirrhosis, and liver cancer.2
Diabetes and liver disease
NAFLD may play a role in the development of type 2 diabetes. If a person has both NAFLD and diabetes, poorly managed diabetes can make the fatty liver disease worse. Other medical conditions, such as hypertension or dyslipidaemia (high cholesterol), can also increase the risk of NAFLD.
As fatty liver disease is linked to diabetes and obesity it is important to assist your patient to manage their diabetes well and to aim to achieve or maintain a healthy weight.
Signs and symptoms of liver disease
Liver disease often remains asymptomatic. Your patients should be warned to seek medical advice if they experience:
- Nausea or vomiting
- Loss of appetite
- Jaundice
- Itchy skin
- Dark urine and/or pale stools
- Chronic fatigue
- Tendency to bruise easily
- Severe abdominal pain
Prevention and screening
Preventative measures include:
- Minimising alcohol intake
- Keeping food safe (prevent food poisoning)
- Using medications wisely
- Avoiding risky behaviours such as unprotected sex, illicit drug use, sharing of needles or syringes
- Avoid contact with other people’s blood and bodily fluids
- Vaccination to reduce the risk of contracting hepatitis
Regular pathology to check the liver function should be part of the annual cycle of care.3 An abdominal ultrasound or a CT scan to examine the liver may also be warranted. The liver review should include a risk assessment tool and clear criteria for further investigation. If liver problems are identified a liver biopsy may be needed to assess the level of inflammation or scarring that may be present.
Treatment
There is no specific treatment for NAFLD; weight loss is the most effective strategy and a reduction of at least 10% is desirable if fatty liver has been diagnosed.4 A combination of a healthy diet and regular physical activity can help in achieving weight loss efforts.
Besides managing diabetes well, it is also important to manage cholesterol and blood pressure.
There are currently no specific medications available for the treatment of fatty liver disease.
More information on diabetes and liver disease
To find out more information on liver disease talk to your healthcare professional, read the fact sheet by the Australian Institute of Health and Welfare or check out the website from the Liver Foundation of Australia.
References
- https://www.healthdirect.gov.au/fatty-liver Last reviewed: January 2021, accessed online 9/2/2022
- David Iser, Marno Ryan. Fatty liver disease A practical guide for GPs. Australian Family Physician, Volume 42, Issue 7, July 2013, accessed online 9/2/2022: https://www.racgp.org.au/afp/2013/july/fatty-liver-disease
- Gracen, L, Hayward, KL, Aikebuse, M, et al. An exploration of barriers and facilitators to implementing a non-alcoholic fatty liver disease pathway for people with type 2 diabetes in primary care. Diabet Med. 2022; 00:e14799. doi:10.1111/dme.14799
- Ghaemi A, Taleban FA, Hekmatdoost A, Rafiei A, Hosseini V, Amiri Z, Homayounfar R, Fakheri H. How much weight loss is effective on non-alcoholic fatty liver disease? Hepatitis monthly. 2013