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Diabetes and Its Liver-Related (Hepatic) Complications

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4 min read


A healthy liver keeps blood sugar levels in normal ranges. The below article unfolds the relationship between diabetes and liver.

Medically reviewed by

Dr. Prabhakar Laxman Jathar

Published At June 30, 2022
Reviewed AtDecember 26, 2022


Diabetes is a metabolic disorder in which the body has high blood glucose levels that affect different body parts. Sugar levels in the body are meticulously controlled by two important hormones called insulin and glucagon, released by the pancreas. Pancreas coordinates with the liver in maintaining blood glucose levels at a normal range at all times. Damage to liver tissues can alter blood glucose levels. Liver disease does not present with symptoms at an early stage. However, serious complications occur when the symptoms start to appear at a later stage.

What Are the Functions of the Liver?

The liver is the largest organ in the body, weighing around 3 pounds. It is wedge-shaped, located on the right side of the abdomen, below the stomach. It performs several crucial functions that are required for normal body functioning. The functions of the liver include the following:

  1. Production of components of the blood.

  2. Digestion.

  3. Metabolism.

  4. Cholesterol production.

  5. Production of hemoglobin.

  6. Detoxification of harmful substances.

  7. Regulating clotting of blood.

  8. Regulating blood glucose levels.

  9. Defense against disease-causing pathogens.

What Is the Connection Between Diabetes and Liver Functioning?

Blood glucose levels are regulated in the body by two hormones, namely insulin and glucagon, which are produced by the pancreas. The liver and pancreas work together to maintain sugar levels at normal. When the body receives glucose in the form of food, special cells called beta cells of the pancreas release insulin into the blood. Insulin acts as a key to let glucose enter the cells. Once a sufficient amount of glucose is taken up by the cells, the excess glucose is converted into glycogen that is stored in the liver.

The alpha cells of the pancreas produce glucagon when the sugar levels in the body start falling. Glucagon acts on the liver and helps release stored glucose into the blood by converting glycogen into glucose. This cycle of the release of insulin and glucagon helps in the proper maintenance of blood sugars.

Diabetes disrupts the balance between the liver and pancreas, which further affects the liver's ability to control blood sugars. Liver dysfunction and diabetes are closely related, where one condition can lead to the other. About 60 to 70 percent of diabetic patients have a condition called non-alcoholic fatty liver disease (NAFLD). Obesity, a sedentary lifestyle, and sleep apnea can increase the risk of developing NAFLD.

What Type of Liver Diseases Are Common in People With Type 2 Diabetes?

About 30.3 million people in the United States have been diagnosed with diabetes, most commonly type 2 diabetes. People with type 2 diabetes are at an increased risk of developing several liver-related issues like non-alcoholic fatty liver disease (NAFLD), scarring of the liver, and liver cancer. NAFLD is the common condition noted in type 2 diabetics.

What Is Non-alcoholic Fatty Liver Disease (NAFLD)?

  • NAFLD is a condition in which excess fat accumulates in the liver cells. The fat build-up in the liver is common in alcoholics. However, in NAFLD, there is fat accumulation in the liver in people who rarely drink or do not drink alcohol.

  • Diabetes and NAFLD are closely interlinked. Studies show that about 50 to 70 percent of people with diabetes develop NAFLD. Similarly, NAFLD tends to worsen in diabetics.

  • NAFLD does not show any symptoms until it is routinely diagnosed in blood tests that detect liver enzyme activity or ultrasound scans.

  • However, sometimes the patient has abdominal pain or swelling. NAFLD can lead to more serious symptoms like liver inflammation, scarring of the liver (cirrhosis), or liver cancer.

What Are the Tips for Good Liver Health in Diabetics?

A healthy lifestyle in diabetics helps prevent NAFLD from developing into a more severe form called non-alcoholic steatohepatitis (NASH), which causes liver tissue inflammation. There are several steps that can be followed by diabetics to help protect the liver and also prevent complications arising from diabetes.

These include:.

  • Managing Blood Sugar: Blood sugar maintenance in diabetics is important in preventing NAFLD. The health care team helps plan the diet, a regular activity schedule, and medications that help keep the sugars under control. The following steps may be advised by the doctors to prevent spikes in the blood glucose levels:

  1. Eat foods high in fiber.

  2. Avoid sweet foods and foods high in fats.

  3. Plan small meals at regular intervals.

  4. Adequate physical activity.

Also, regular monitoring of the blood sugar is advised by the doctor.

  • Maintaining Body Weight: Most people with type 2 diabetes are obese. Obesity can be a contributing factor to NAFLD. Losing weight helps in reducing liver fat and also prevents liver cancer. The health care team can guide patients about healthy ways of losing weight.

  • Following a Healthy Diet: The doctor may advise dietary changes to control blood sugars, which in turn prevent liver disease and its complications. Patients are advised to include nutritious foods high in fiber like fruits, vegetables, and whole grains and limit the intake of foods high in fats, salt, and sugar. Mindful eating at regular intervals also helps manage blood sugars.

  • Regular Physical Activity: The doctor may advise a physical activity five days a week for at least 30 minutes each day. The activity requires fuel, which is obtained by burning triglycerides (a type of harmful fat), thereby reducing fat levels in the liver.

  • Limiting Alcohol Intake: Alcohol intake creates many health problems in general and liver problems in particular. Alcohol damages the liver cells causing complications. Hence it is advised to reduce alcohol intake or completely avoid it.

  • Controlling High Blood Pressure: Managing blood pressure is essential in preventing liver diseases. The following steps can help in maintaining blood pressure levels at normal:

  • Reduce sodium in the diet.

  • Quit smoking.

  • Decrease intake of caffeine.

  • Regular exercise.

  • Healthy diet.

When to Consult a Doctor?

In most cases, NAFLD does not show any symptoms. However, a consultation with the doctor regularly is necessary. The doctor may detect liver disease through routine blood tests or ultrasound scans.

The doctor must also be kept informed in case the following symptoms appear:

  • Abdominal pain and swelling.

  • Yellowish discoloration of the skin and eyes is called jaundice.

  • Swelling of the ankles or legs.

  • Itching of the skin.

  • Dark-colored urine.

  • Tar colored stools.

  • Blood in stools.

  • Nausea and vomiting.

  • Loss of appetite.

  • Increase in bruises.

  • Tiredness.


Liver disease is one of the serious complications of type 2 diabetes. As liver diseases do not show noticeable symptoms till the complications like liver tissue scarring, liver failure, or cancer occur, regular check-ups with the doctor periodically are pivotal. Screening for liver diseases helps assess and start lifestyle measures at an early stage. Healthy food intake, regular physical activity, managing weight, and quitting alcohol can help reverse liver diseases and improve liver health.

Frequently Asked Questions


How Does Diabetes Affect the Liver?

Nonalcoholic fatty liver disease is more likely in those with diabetes. Fat builds up in the liver even when patients with this illness consume little or no alcohol. At least 50 % of type 2 diabetics have nonalcoholic fatty liver disease.


What Is a Hepatic Complication?

Hepatic dysfunction exhibits a broad spectrum of clinical signs and is one of the most frequent consequences following major surgical intervention. Hepatology's recent advances have improved the overall understanding of the causes, pathophysiology, and consequences of hepatic dysfunction.


Can Liver Disease Be Treated?

Certain liver conditions can be managed with lifestyle changes, such as giving up drinking or decreasing weight, usually as part of a medical plan that also includes continuous liver function monitoring. Some liver issues may need surgery or medication management.


What Is Hepatic Failure’s First Sign?

The early signs and symptoms of hepatic or liver failure are:
- Jaundice (yellowish discoloration of skin and mucosa).
- Abdominal discomfort.
- Swelling of the abdomen


What Hepatic Condition Is the Most Prevalent?

Hepatitis viruses are the most prevalent types of liver infection, including Hepatitis A (transmitted through contaminated food or water) and the hepatitis B virus (blood and other body fluids, including semen, can spread this infection).


Which Organs Suffer From Diabetes Complications?

Damage to the main blood vessels (macrovascular complications) of the heart, brain, and legs and damage to the small blood vessels  (microvascular complications), which result in issues with the eyes, kidneys, feet, and nerves, are the two most frequent long-term diabetes-related health issues.


Which Types of Diabetes Are Liver-Related?

Around 30 % of those who have cirrhosis also have diabetes mellitus (DM). The possibility of type 2 diabetes being a risk factor for chronic liver disease in the absence of obesity and hypertriglyceridemia is now under discussion. Hepatogenous diabetes (DM) is a cirrhosis-related consequence of DM.


Why Do Diabetics Get Liver Issues?

The combination of increased oxidative stress and an abnormal inflammatory response, which damages hepatocytes and stimulates the transcription of pro-apoptotic genes, is the fundamental mechanism of diabetes that causes liver damage.


Do Liver Tests Reveal Diabetes?

Even within the normal range, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), and -glutamyltranspeptidase (GGT) levels were independently linked to a higher risk of diabetes. Some research findings suggested that increased liver enzymes may serve as indicators for the likely presence of diabetes.


How Does the Liver Affect Blood Sugar?

The liver serves as the body's source of glucose (or fuel) and aids in maintaining steady blood sugar levels and other body fuel levels. Depending on the body's requirements, the liver produces and stores glucose.


Which Organ, Specifically, Is Affected In Diabetes?

Diabetes occurs when either insufficient amounts of the hormone insulin are produced by the pancreas, a gland beneath the stomach, or when the body has difficulties using it. Insulin aids in the movement of circulation sugar into cells. Sugar is transformed into energy once within the cells, either for now or for later.


Can a Heavy Sugar Diet Lead To Liver Issues?

Regular consumption of sugar causes chemicals to accumulate in the body, which can eventually damage the liver and other internal organs. A diseased liver cannot function as effectively as one that is healthy.


What Causes Fatty Liver in Diabetics?

In the context of pre-diabetes or overt diabetes, higher glucose levels provide additional substrate for triglyceride production. Hepatic fat accumulation is also aided by impaired very low-density lipoprotein (VLDL) secretion, which frequently results from insulin resistance, leading to fatty liver.
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Dr. Prabhakar Laxman Jathar
Dr. Prabhakar Laxman Jathar



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