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Diabetes and Liver Disease Are Entangled


November is National Diabetes Month. Learn how closely liver disease and diabetes are connected.

Mass education campaigns have helped increase our awareness of the connection between poor lifestyle habits and Type II Diabetes, but few realize how they also affect the liver’s health. The association between diabetes and liver disease is not coincidental; in fact, the two health conditions may just be different sides of the same metabolic coin.

Type II Diabetes

Also referred to as adult onset diabetes and non-insulin dependent diabetes, Type II diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose).

Those with Type II diabetes have a problem with insulin – a hormone released by the pancreas that regulates the movement of sugar into the cells. Type II diabetics belong to one of the following two categories:

  1. Their body resists the effects of insulin.
  2. Their body doesn’t produce enough insulin to maintain a normal glucose level.

Diabetes leads to high blood glucose levels, a problem that can have a wide range of consequences, and some are life-threatening. Several examples include:

  • Cardiovascular disease – which can lead to heart attack or stroke
  • Nerve damage – which can lead to sensation loss and/or dementia
  • Kidney damage – which can lead to kidney failure
  • Eye damage – which can lead to blindness
  • Infection of the foot – which can lead to amputation

Those who have Type II diabetes must monitor their blood glucose levels and may need medication to keep those levels steady. In addition, lifestyle factors like eating healthy and exercising regularly are crucial for a diabetic’s wellness.

Liver Disease

Located in the upper right abdomen, the liver is our body’s largest internal organ. The liver is responsible for an estimated 500 jobs in human physiology; its ability to function is a requirement for life. Besides being our body’s detoxification center, the liver is also involved in fat digestion, hormone production and making and storing glucose.

Liver disease is a broad term that covers all the potential problems causing liver cell damage, which can impair the liver’s ability to perform its designated functions. The liver is the only organ in the body that can easily replace damaged cells. However, repeated liver cell damage can result in permanent injury to this valued organ. Liver tissue scarring is known as fibrosis, while fibrosis that has permanently hardened and shrunk is called cirrhosis. Not a condition to be taken lightly, cirrhosis is the 12th leading cause of death by disease in the U.S.

Some of the more common culprits of liver disease include:

  • Hepatitis C – One of the types of viral hepatitis that is not preventable via vaccination and can lead to chronic liver disease, Hepatitis C is spread primarily via infected blood-to-blood contact. An estimated four to five million Americans are currently infected with the Hepatitis C virus.
  • Non-alcoholic liver disease (NAFLD) – Also referred to as a fatty liver, NAFLD describes the accumulation of fat within the liver that can cause inflammation and a gradual decrease in liver function. An estimated 25 to 30 percent of American adults have some degree of NAFLD.
  • Alcoholic liver disease – One of the most common causes of liver disease in North America, alcohol kills liver cells. Alcohol is directly toxic to liver cells and its repetitive, over-consumption prohibits new liver cells from replacing injured ones.

Connecting Diabetes and Liver Disease

The co-morbidity of diabetes and chronic liver disease is much higher than most people fathom. In a March 2007 edition of the journal Diabetes Care, American researchers found the following:

  • The prevalence of NAFLD in those with diabetes is estimated at 34–74 percent and, in diabetics who are obese, at virtually 100 percent.
  • The association of cirrhosis and diabetes is complicated by the fact that cirrhosis itself is associated with insulin resistance. Impaired glucose tolerance is seen in 60 percent of those with cirrhosis and diabetes occurs in 20 percent of patients with cirrhosis.
  • There is a fourfold increased prevalence of hepatocellular carcinoma (primary liver cancer) in people with diabetes.

Although there are many possible risk factors for developing Type II diabetes and NAFLD, consistently high blood glucose levels can cause both. There is no medication for the treatment of a fatty liver, but the most important course of action is:

  1. Losing excess weight with lifestyle modifications
  2. Eating well – consuming a low-fat, high-fiber, low-sugar diet
  3. Exercising regularly

All three of these steps also help prevent diabetes because these steps help maintain steady blood glucose levels, improving the body’s ability to metabolize sugar. In addition, some healthcare professionals suggest natural supplements that are intended to support healthful insulin function, minimize liver cell damage and promote ideal blood glucose levels.

The Insulin Link

Insulin is a major factor in understanding why diabetes and liver disease are linked. The liver is an insulin-guided organ, its behavior changes depending on:

  • the level of insulin in the body
  • how sensitive the liver is to that insulin

Normally, blood glucose levels rise after eating, triggering the pancreas to release insulin into the bloodstream.

  • Insulin signals the body to absorb glucose from the blood.
  • When glucose levels are high in the blood, the liver responds to the insulin by absorbing glucose and packaging it into glycogen bundles.
  • When glucose levels are low in the blood, the liver sends glucose back into the bloodstream.

In people with diabetes, the liver is not able to package, store and release glucose normally, adding to the challenge of blood glucose control. Although experts believe there are many different ways NAFLD can begin, one theory blames it on insulin resistance in the liver. An insulin-resistant liver ignores the hormone’s signal to stop sending glucose to the blood, raising blood glucose levels and increasing the likelihood of localized inflammation and fat accumulation. Anyone at risk of insulin resistance, when the cells lose their ability to respond to insulin, is at increased risk of developing Type II diabetes and NAFLD.

When the liver’s ability to metabolize glucose suffers, insulin resistance, fat accumulation in the liver and diabetes can result. The clear solution to these related problems is to improve the liver’s metabolic health – a feat that is attainable with a healthful diet, regular exercise and natural metabolic support., How Sugar Messes Messes Up Your Liver and Gives You Diabetes, Kris Gunnars, Retrieved September 29, 2013,, 2013., Spectrum of Liver Disease in Type 2 Diabetes and Management of Patients With Diabetes and Liver Disease, KG Tolman, et al, Retrieved September 29, 2013, Diabetes Care, March 2007., The Liver’s Role: How It Processes Fats and Carbs, Erika Gebel, PhD, Retrieved September 29, 2013, American Diabetes Association, 2013., Diabetes Statistics, September 29, 2013, American Diabetes Association, 2013., Type 2 Diabetes, Retrieved September 29, 2013, Mayo Foundation for Medical Education and Research, 2013., Liver Disease, Benjamin Wedro, MD, FACEP, FAAEM, Retrieved September 29, 2013, MedicineNet, Inc., 2013.

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About the Author

Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.

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