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Can Cirrhosis Of The Liver Be Caused By Diabetes?

Spectrum Of Liver Disease In Type 2 Diabetes And Management Of Patients With Diabetes And Liver Disease

Spectrum Of Liver Disease In Type 2 Diabetes And Management Of Patients With Diabetes And Liver Disease

It is estimated that 20.8 million people, i.e., 7.0% of the U.S. population, have diabetes (1). Type 2 diabetes, with its core defects of insulin resistance and relative insulin deficiency, accounts for 90–95% of those with the disease. Another 5.2 million people are estimated to have undiagnosed type 2 diabetes. It is the sixth leading cause of death (1) in the U.S. and accounts for 17.2% of all deaths for those aged >25 years (2). Liver disease is an important cause of death in type 2 diabetes. In the population-based Verona Diabetes Study (3), cirrhosis was the fourth leading cause of death and accounted for 4.4% of diabetes-related deaths. The standardized mortality ratio (SMR), i.e., the relative rate of an event compared with the background rate, for cirrhosis was 2.52 compared with 1.34 for cardiovascular disease (CVD). In another prospective cohort study (4), cirrhosis accounted for 12.5% of deaths in patients with diabetes. Diabetes, by most estimates, is now the most common cause of liver disease in the U.S. Cryptogenic cirrhosis, of which diabetes is, by far, the most common cause, has become the third leading indication for liver transplantation in the U.S. (5,6). Virtually the entire spectrum of liver disease is seen in patients with type 2 diabetes. This includes abnormal liver enzymes, nonalcoholic fatty liver disease (NAFLD), cirrhosis, hepatocellular carcinoma, and acute liver failure. In addition, there is an unexplained association of diabetes with hepatitis C. Finally, the prevalence of diabetes in cirrhosis is 12.3–57% (7). Thus, patients with diabetes have a high prevalence of liver disease and patients with liver disease have a high prevalence of diabetes. The management of diabetes in patients with liver disease is theoretically complicated b Continue reading >>

What Every Diabetic Should Know About Liver Disease

What Every Diabetic Should Know About Liver Disease

What Every Diabetic Should Know About Liver Disease Did you know that diabetics are 50% more likely to develop liver disease? Particularly fatty liver disease. Fatty liver disease is incredibly common in overweight people; nearly everyone with excess weight on their abdomen has some degree of fatty liver. Type 2 diabetics are prone to carrying excess weight on their abdomen, but even slim diabetics often have a fatty liver. It is well known that diabetes increases the risk of kidney disease, nerve damage, blood vessel damage, infections, blindness, erectile problems and heart disease, but you may not realise diabetes has terrible effects on the liver. You can’t see or feel the effects it’s having on your liver until liver cells become damaged. According to Gillian Booth, MD, MSc, of St. Michael’s Hospital in Toronto, in a population-based study, newly diagnosed diabetes was linked with a near doubling in the rate of cirrhosis, liver failure or liver transplant compared with non-diabetics. Clearly these are significant findings that should be taken seriously. Insulin resistance (syndrome X) is the driving force behind the development of fatty liver. Insulin resistance is a forerunner to type 2 diabetes. If the insulin resistance becomes severe enough, a person usually develops type 2 diabetes. Type 1 diabetes usually develops in childhood, although by the time they are in their mid 30s, most type 1 diabetics have developed insulin resistance as well, and they face the same risks as type 2 diabetics when they get older. People with insulin resistance have high levels of insulin in their bloodstream. Insulin signals to your liver to manufacture fat, especially triglycerides and cholesterol. This promotes the accumulation of fat inside the liver, inside other organs, Continue reading >>

Liver Cirrhosis And Diabetes: Risk Factors, Pathophysiology, Clinical Implications And Management

Liver Cirrhosis And Diabetes: Risk Factors, Pathophysiology, Clinical Implications And Management

Go to: About 30% of patients with cirrhosis have diabetes mellitus (DM). Nowadays, it is a matter for debate whether type 2 DM in the absence of obesity and hypertriglyceridemia may be a risk factor for chronic liver disease. DM, which develops as a complication of cirrhosis, is known as “hepatogenous diabetes”. Insulin resistance in muscular and adipose tissues and hyperinsulinemia seem to be the pathophysiologic bases of diabetes in liver disease. An impaired response of the islet β-cells of the pancreas and hepatic insulin resistance are also contributory factors. Non-alcoholic fatty liver disease, alcoholic cirrhosis, chronic hepatitis C (CHC) and hemochromatosis are more frequently associated with DM. Insulin resistance increases the failure of the response to treatment in patients with CHC and enhances progression of fibrosis. DM in cirrhotic patients may be subclinical. Hepatogenous diabetes is clinically different from that of type 2 DM, since it is less frequently associated with microangiopathy and patients more frequently suffer complications of cirrhosis. DM increases the mortality of cirrhotic patients. Treatment of the diabetes is complex due to liver damage and hepatotoxicity of oral hypoglycemic drugs. This manuscript will review evidence that exists in relation to: type 2 DM alone or as part of the metabolic syndrome in the development of liver disease; factors involved in the genesis of hepatogenous diabetes; the impact of DM on the clinical outcome of liver disease; the management of DM in cirrhotic patients and the role of DM as a risk factor for the occurrence and exacerbation of hepatocellular carcinoma. Keywords: Insulin resistance, Type 2 diabetes mellitus, Liver cirrhosis, Hepatocellular carcinoma, Chronic hepatitis C Continue reading >>

Can Diabetes Cause Cirrhosis?

Can Diabetes Cause Cirrhosis?

Can Diabetes Cause Complications to the Liver and Kidneys Can diabetes cause liver and kidney issues? Uncontrolled diabetes is known to cause diabetic nephropathy. But liver disease? Find out. Overview Can diabetes cause liver and kidney issues? This is a common question among diabetics. By definition, diabetes is a disease characterized by high levels of blood sugar due to the lack of insulin in the body or to the body’s inability to respond to the presence of insulin. Insulin is the hormone that allows the sugar to get to the cells and provide them with energy. Uncontrolled diabetes can frequently result in many complications which cause damage to important body organs like the liver, kidneys, eyes and nerves. It can also result in other conditions like heart disease and stroke. It can lead to diabetic ketoacidosis as the body fats are being used for energy. Diabetic ketoacidosis, if not managed early, can become life threatening. Other complications of diabetes are skin and mouth infections, bone problems, like osteoporosis, and foot damage. Diabetes may put a person at risk of developing liver and kidney disease. Some of the more common liver and kidney complications of diabetes are non-alcoholic cirrhosis and diabetic nephropathy. Non-alcoholic cirrhosis Cirrhosis, or the scarring of the liver, is often associated with alcohol abuse, but it can also be a complication of diabetes. Non-alcoholic cirrhosis is a general term for the scarring of the liver not due to excess alcohol consumption. In this condition, the liver is hardened is unable to function normally.High levels of sugar and cholesterol in the blood, as well as obesity, are considered contributing factors to the development of non-alcoholic liver cirrhosis in diabetic patients. Use of some drugs for the Continue reading >>

Metformin, The Liver, And Diabetes

Metformin, The Liver, And Diabetes

Most people think diabetes comes from pancreas damage, due to autoimmune problems or insulin resistance. But for many people diagnosed “Type 2,” the big problems are in the liver. What are these problems, and what can we do about them? First, some basic physiology you may already know. The liver is one of the most complicated organs in the body, and possibly the least understood. It plays a huge role in handling sugars and starches, making sure our bodies have enough fuel to function. When there’s a lot of sugar in the system, it stores some of the excess in a storage form of carbohydrate called glycogen. When blood sugar levels get low, as in times of hunger or at night, it converts some of the glycogen to glucose and makes it available for the body to use. Easy to say, but how does the liver know what to do and when to do it? Scientists have found a “molecular switch” called CRTC2 that controls this process. When the CRTC2 switch is on, the liver pours sugar into the system. When there’s enough sugar circulating, CRTC2 should be turned off. The turnoff signal is thought to be insulin. This may be an oversimplification, though. According to Salk Institute researchers quoted on RxPG news, “In many patients with type II diabetes, CRTC2 no longer responds to rising insulin levels, and as a result, the liver acts like a sugar factory on overtime, churning out glucose [day and night], even when blood sugar levels are high.” Because of this, the “average” person with Type 2 diabetes has three times the normal rate of glucose production by the liver, according to a Diabetes Care article. Diabetes Self-Management reader Jim Snell brought the whole “leaky liver” phenomenon to my attention. He has frequently posted here about his own struggles with soarin Continue reading >>

Liver Disease And Diabetes Mellitus

Liver Disease And Diabetes Mellitus

CLINICAL DIABETES VOL. 17 NO. 2 1999 These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. FEATURE ARTICLE Gavin N. Levinthal, MD, and Anthony S. Tavill, MD, FRCP, FACP IN BRIEF Liver disease may cause or contribute to, be coincident with, or occur as a result of diabetes mellitus. This article addresses these associations. This article addresses the role of the liver in normal glucose homeostasis and discusses a variety of liver conditions associated with abnormal glucose homeostasis. This association may explain the pathogenesis of the liver disease or of the abnormal glucose homeostasis, or may be purely coincidental (Table 1). Table 1. Liver Disease and Diabetes Mellitus 1. Liver disease occurring as a consequence of diabetes mellitus Glycogen deposition Steatosis and nonalcoholic steatohepatitis (NASH) Fibrosis and cirrhosis Biliary disease, cholelithiasis, cholecystitis Complications of therapy of diabetes (cholestatic and necroinflammatory) 2 . Diabetes mellitus and abnormalities of glucose homeostasis occurring as a complication of liver disease Hepatitis Cirrhosis Hepatocellular carcinoma Fulminant hepatic failure Postorthotopic liver transplantation 3 . Liver disease occurring coincidentally with diabetes mellitus and abnormalities of glucose homeostasis Hemochromatosis Glycogen storage diseases Autoimmunebiliary disease The prevalence of type 1 diabetes in the United States is ~0.26%. The prevalence of type 2 diabetes is far higher, ~1–2% in Caucasian Americans and up to 40% in Pima Indians. According to the Centers for Disease Control and Prevention, hepatitis C alone chronically infects more than 1.8% of the A Continue reading >>

The Link Between Hepatitis C And Diabetes

The Link Between Hepatitis C And Diabetes

Diabetes is on the rise in the United States. According to the American Diabetes Association, the number of people with diagnosed diabetes in the United States increased by almost 400 percent from 1988 to 2014. Healthy lifestyle habits can help prevent many cases of type 2 diabetes. But poor lifestyle choices are only some of the risks for developing this condition. The chronic form of the hepatitis C virus (HCV) has been shown to be a risk factor for the development of both type 1 and type 2 diabetes. And people with diabetes are likely to have a more complicated course of chronic HCV. The most common way to get the hepatitis C virus is through exposure to infected blood. This can happen by: injecting drugs with a syringe previously used by an infected person sharing a personal hygiene item, like a razor, used by an infected person getting a tattoo or a body piercing with a needle that has infected blood within it There is no vaccine to prevent HCV. So it’s important to know the risks of contracting the HCV virus, and how your health may be affected in the long-term. Hepatitis is a condition that causes liver inflammation and can lead to liver damage. It’s often caused by a virus. The most common hepatitis viruses in the United States are: Hepatitis C is of concern because about 75 to 85 percent of people who become infected with hepatitis C will develop the chronic form of the disease. Chronic HCV can prevent the liver from performing its basic functions, including: aiding in digestion normal blood clotting protein production nutrient and energy storage preventing infection waste elimination from bloodstream Since chronic HCV can impact the many functions that your liver performs, the disease can be detrimental to your health. Chronic HCV can also increase your ch Continue reading >>

What Is Cirrhosis?

What Is Cirrhosis?

Cirrhosis develops when scar tissue replaces normal, healthy tissue in your liver. It happens after the healthy cells are damaged over a long period of time, usually many years. The scar tissue makes the liver lumpy and hard, and after a while, the organ will start to fail. The scar tissue makes it tough for blood to get through a large vein (the portal vein) that goes into the liver. When blood backs up into the portal vein, it can get into your spleen and cause trouble in that organ, too. There’s no cure for cirrhosis except a liver transplant, but you and your doctor can slow cirrhosis down by treating whatever is causing it. This disease always develops as a result of other liver conditions or diseases you already have. They include: Alcohol-related liver disease. Drinking too much alcohol for years on end raises your risk of cirrhosis. It causes fat and inflammation in the liver. The amount of alcohol it takes to hurt the liver is different for everyone. But in general, women shouldn’t have more than one drink a day. Men shouldn’t have more than two. Viral hepatitis. Hepatitis is inflammation of the liver. It can be caused by heavy alcohol use, some medications and certain medical conditions. Most often, a virus causes it. Hepatitis C is the most common hepatitis in the United States, followed by hepatitis B. You can get either of these by coming into contact with infected blood. This might happen if you: Stick yourself with a needle by accident Share needles to inject drugs Had a blood transfusion in the past (before the mid-1980s for Hep B, before 1992 for Hep C) Have sex with someone who has it Hepatitis D can also cause cirrhosis. But you can only get this type of hepatitis if you already have hepatitis B. Nonalcoholic fatty liver disease. Fat can build u Continue reading >>

The Relationship Between Diabetes Mellitus, Cirrhosis, And Hepatocellular Carcinoma In Patients With Fatty Liver Disease

The Relationship Between Diabetes Mellitus, Cirrhosis, And Hepatocellular Carcinoma In Patients With Fatty Liver Disease

The Relationship between Diabetes Mellitus, Cirrhosis, and Hepatocellular Carcinoma in Patients with Fatty Liver Disease Diabetes mellitus is an independent predictor of cirrhosis and hepatocellular carcinoma (HCC) among patients with fatty liver disease, according to study results presented by lead author Evan Raff, MD, of the department of Internal Medicine, University of Alabama at Birmingham, during a poster session at the 2013 American College of Gastroenterology in San Diego, CA. Diabetes mellitus is among the risk factors for chronic liver disease, along with infection with hepatitis B or C virus, heavy alcohol consumption, and nonalcoholic fatty liver disease. In this retrospective study, to explore the relationship between diabetes and the progression of steatohepatitis, also known as fatty liver disease, researchers looked at medical charts from 2007 to 2011 of patients whose steatohepatitis-related disease was managed at a single tertiary center. The data review included demographics; comorbidities including diabetes mellitus, cirrhosis and complications, and hepatocellular carcinoma; and laboratory, imaging and histology. Other causes of liver disease and excess history of alcohol use were excluded in diagnosis. Patients with and without diabetes mellitus were compared using chi-square and t-tests for categorical and continuous variables, respectively. Independent association of diabetes mellitus with cirrhosis and hepatocellular carcinoma were examined using a logistic regression model and data were reported as an odds ratio with a 95 percent confidence interval. Among the 503 patients with steatohepatitis, 276 had nonalcoholic steatohepatitis. Patients with diabetes compared to those without were more often female, obese, consumed less than one alcoholic Continue reading >>

Type 2 Diabetes And Fatty Liver Disease

Type 2 Diabetes And Fatty Liver Disease

Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver. Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.” Fatty Liver Disease and Type 2 Diabetes: The Connection Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains. Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis. Fatty Liver Disease Diagnosis Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ul Continue reading >>

Cirrhosis

Cirrhosis

On this page: What are the signs and symptoms of cirrhosis? What is cirrhosis? Cirrhosis is a condition in which the liver slowly deteriorates and is unable to function normally due to chronic, or long lasting, injury. Scar tissue replaces healthy liver tissue and partially blocks the flow of blood through the liver. The liver is the body’s largest internal organ. The liver is called the body’s metabolic factory because of the important role it plays in metabolism—the way cells change food into energy after food is digested and absorbed into the blood. The liver has many functions, including taking up, storing, and processing nutrients from food—including fat, sugar, and protein—and delivering them to the rest of the body when needed making new proteins, such as clotting factors and immune factors producing bile, which helps the body absorb fats, cholesterol, and fat-soluble vitamins removing waste products the kidneys cannot remove, such as fats, cholesterol, toxins, and medications A healthy liver is necessary for survival. The liver can regenerate most of its own cells when they become damaged. However, if injury to the liver is too severe or long lasting, regeneration is incomplete, and the liver creates scar tissue. Scarring of the liver, also called fibrosis, may lead to cirrhosis. The buildup of scar tissue that causes cirrhosis is usually a slow and gradual process. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse and scar tissue replaces more healthy tissue, the liver will begin to fail. Chronic liver failure, which is also called end-stage liver disease, progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or effectively rep Continue reading >>

Cirrhosis Of The Liver: Causes, Symptoms, And Treatments

Cirrhosis Of The Liver: Causes, Symptoms, And Treatments

Cirrhosis of the liver describes a condition where scar tissue gradually replaces healthy liver cells. It is a progressive disease, developing slowly over many years. If it is allowed to continue, the buildup of scar tissue can eventually stop liver function. For cirrhosis to develop, long-term, continuous damage to the liver needs to occur. When healthy liver tissue is destroyed and replaced by scar tissue, the condition becomes serious, because it can start blocking the flow of blood through the liver. This MNT Knowledge Center article explains the symptoms, causes, and treatments of liver cirrhosis, including information about complications. One of the primary methods of diagnosis is through a blood test. Symptoms are not common during the early stages of cirrhosis. However, as scar tissue accumulates, the ability of the liver to function properly is undermined. The following signs and symptoms may occur: blood capillaries become visible on the skin on the upper abdomen. The liver tissue is replaced by fibrous scar tissue. Regenerative nodules may also form. These are lumps that appear as the liver tries to heal the damage. If the cirrhosis is diagnosed early enough, damage can be minimized by treating the underlying cause or the various complications that arise. Treatment for alcohol dependency: It is important for the patient to stop drinking if their cirrhosis was caused by long-term, regular heavy alcohol consumption. In many cases, the doctor will recommend a treatment program for treating alcohol dependency. Medications: The patient may be prescribed drugs to control liver cell damage caused by hepatitis B or C. Controlling pressure in the portal vein: Blood can "back up" in the portal vein that supplies the liver with blood, causing high blood pressure in the Continue reading >>

The Liver & Blood Sugar

The Liver & Blood Sugar

During a meal, your liver stores sugar for later. When you’re not eating, the liver supplies sugar by turning glycogen into glucose in a process called glycogenolysis. The liver both stores and produces sugar… The liver acts as the body’s glucose (or fuel) reservoir, and helps to keep your circulating blood sugar levels and other body fuels steady and constant. The liver both stores and manufactures glucose depending upon the body’s need. The need to store or release glucose is primarily signaled by the hormones insulin and glucagon. During a meal, your liver will store sugar, or glucose, as glycogen for a later time when your body needs it. The high levels of insulin and suppressed levels of glucagon during a meal promote the storage of glucose as glycogen. The liver makes sugar when you need it…. When you’re not eating – especially overnight or between meals, the body has to make its own sugar. The liver supplies sugar or glucose by turning glycogen into glucose in a process called glycogenolysis. The liver also can manufacture necessary sugar or glucose by harvesting amino acids, waste products and fat byproducts. This process is called gluconeogenesis. When your body’s glycogen storage is running low, the body starts to conserve the sugar supplies for the organs that always require sugar. These include: the brain, red blood cells and parts of the kidney. To supplement the limited sugar supply, the liver makes alternative fuels called ketones from fats. This process is called ketogenesis. The hormone signal for ketogenesis to begin is a low level of insulin. Ketones are burned as fuel by muscle and other body organs. And the sugar is saved for the organs that need it. The terms “gluconeogenesis, glycogenolysis and ketogenesis” may seem like compli Continue reading >>

Diabetes: How Do I Help Protect My Liver?

Diabetes: How Do I Help Protect My Liver?

If I have diabetes, is there anything special I need to do to take care of my liver? Answers from M. Regina Castro, M.D. You're wise to wonder about steps to protect your liver. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes. It isn't clear whether the condition appears more often in people with type 1 diabetes than in the general population because obesity, which is a risk factor, occurs with similar frequency in both groups. Other medical conditions, such as high cholesterol and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer, heart disease and kidney disease. Fatty liver disease may even play a role in the development of type 2 diabetes. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse. Your best defense against fatty liver disease includes these strategies: Work with your health care team to achieve good control of your blood sugar. Lose weight if you need to, and try to maintain a healthy weight. Take steps to reduce high blood pressure. Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits. Don't drink too much alcohol. If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function. Continue reading >>

Fatty Liver (nonalcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis)

Fatty Liver (nonalcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis)

Nonalcoholic fatty liver disease definition facts Nonalcoholic fatty liver disease (non-alcoholic fatty liver disease, NAFLD) is the accumulation of abnormal amounts of fat within the liver. Nonalcoholic fatty liver disease can be divided into isolated fatty liver in which there is only accumulation of fat, and nonalcoholic steatohepatitis (NASH) in which there is fat, inflammation, and damage to liver cells. NASH progresses to scarring and ultimately to cirrhosis, with all the complications of cirrhosis, for example, gastrointestinal bleeding, liver failure, and liver cancer. The development of nonalcoholic fatty liver disease is intimately associated with and is probably caused by obesity and diabetes. Nonalcoholic fatty liver disease is considered a manifestation of the metabolic syndrome. The symptoms of nonalcoholic fatty liver disease are primarily those of the complications of cirrhosis in patients with NASH; isolated fatty liver infrequently causes symptoms and usually is discovered incidentally. The complications of cirrhosis include: The differentiation of isolated fatty liver from NASH usually requires a liver biopsy. The most promising treatments for nonalcoholic fatty liver disease are Several drugs have been studied in the treatment of NASH. There is little evidence that any drug is effective in slowing the disease progression of NASH. Many diseases are associated with NASH and are part of the metabolic syndrome. These diseases should be screened for and treated, for example, high blood pressure, dyslipidemia and diabetes. Isolated fatty liver rarely progresses to NASH or cirrhosis. Nonalcoholic fatty liver disease, including NASH affects young children as well. NASH will become the number one reason for liver transplantation unless effective and safe trea Continue reading >>

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