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Challenges of Managing Diabetes With Liver Involvement

written by: Sanchia Fernandes • edited by: Leigh A. Zaykoski • updated: 5/31/2011

Diabetes has been found to be the most common cause of liver disease. Poor control of blood sugar levels in conjunction with high cholesterol levels and obesity can increase a patient’s risk of developing liver problems.

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    The Diabetes-Liver Disease Link

    Diabetics are prone to abnormal liver enzymes, resulting in fatty liver disease and chronic hepatitis. Fatty liver disease is similar to alcoholic liver disease and can result in cirrhosis of the liver if diabetes is not properly managed. Cirrhosis is a major cause of death in diabetic patients. Such patients are resistant to insulin, so this factor should be considered when treating a diabetic patient with cirrhosis.

    Liver cancer, known as hepatocellular carcinoma, is four times more prevalent in diabetics than in other patients. The same is true for acute liver failure and the incidence of hepatitis C. In addition, medications used to treat diabetes and high cholesterol levels can also cause liver damage. Administration of insulin can increase the risk of liver infection as a result of frequent injections.

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    Pharmacologic Therapy for Diabetics with Liver Disease

    Pharmacologic therapy for diabetics with liver disease is similar to that for diabetics without liver disease. However, patients with fatty liver disease are treated with thiazolidinediones (TZDs) in preference to insulin, as such patients are resistant to insulin.

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    Treatment Challenges

    darrenhester/morgueFile A modification in lifestyle is crucial to the management of diabetes in patients with concurrent liver disease. Since diabetics tend to have high levels of blood sugar, they should be placed on a low-glycemic diet. The diet should consist of low amounts of red meat, but should be rich in high complex carbohydrates and high in mono-unsaturated fats. Alcohol should be avoided by diabetics with liver involvement since it has a high caloric content, can react adversely with sulfonylureas and has a toxic affect on the liver. Regular exercise improves peripheral insulin sensitivity and should be included in the treatment program.

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    Additional Considerations

    Liver involvement hould be carefully taken into consideration when determining the course of treatment for the diabetic patient. A diabetic can guard against liver disease by controlling his blood sugar levels and maintaining a healthy weight. Such a patient should not drink alcohol and should reduce cholesterol levels by adhering to the diet advised by the specialist. Regular testing of blood sugar levels should be accompanied by regular testing of liver function, especially if medications administered to control the diabetes could adversely affect the liver. In patients with liver involvement, strict management of diabetes prevents further liver damage by reducing the amount of fat that accumulates in the liver.

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    Diabetes is associated with many liver diseases, but the treatment of diabetes is not altered by the presence of the liver disease. However, diabetics with liver problems should be monitored more carefully so that complications don’t arise. Specialists should particularly pay due consideration to health problems such as alterations to drug metabolism by the liver, interactions between different drugs, and the risk of hepatotoxicity when treating a diabetic with liver disease.

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