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 >>
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 >>
Diabetes-related Causes Of Enlarged Liver
Diabetes-related causes of Enlarged liver Our information shows that 5causes of Enlarged liver are related to diabetes, or a family history of diabetes (from a list of 1314total causes).These diseases and conditions may be more likely causes of Enlarged liver if the patient has diabetes,is at risk of diabetes, or has a family history of diabetes. The full list of all possible causes for Enlarged liver described in various sources is as follows: Drug side effect causes of Enlarged liver The following drugs, medications, substances or toxins may possibly cause Enlarged liver as a side effect. [ See detailed list of 2drug side effect causes of Enlarged liver ] Conditions listing medical symptoms: Enlarged liver: The following list of conditionshave ' Enlarged liver ' or similarlisted as a symptom in our database.This computer-generated list may be inaccurate or incomplete.Always seek prompt professional medical advice about the causeof any symptom. Select from the following alphabetical view of conditions whichinclude a symptom of Enlarged liver or choose View All. View All A B C D E F G H I J K L M N O P Q R S T U V W X Z # Conditions listing medical complications: Enlarged liver: The following list of medical conditions have ' Enlarged liver ' or similar listed as a medical complication in our database. By using this site you agree to our Terms of Use . Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use . Continue reading >>
Case Report J Med Cases €¢ 2013;4(11):726-728 Presselmer
Articles © The authors | Journal compilation © J Med Cases and Elmer Press Inc™ | www.journalmc.org This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Hepatomegaly in Type 1 Diabetes Mellitus: When to Suspect of Glycogenic Hepatopathy? Joana Jardima, c, Eunice Trindadea, Fatima Carneirob, Jorge Amil Diasa Abstract Uncontrolled type 1 diabetes mellitus is associated with recog- nized short- and long-term complications. The authors describe a case of a female adolescent, with history of poorly controlled type 1 diabetes mellitus, who presented with tender hepatomegaly and elevated liver enzymes. Her growth and pubertal development were appropriated for age. After excluding infectious and autoimmune causes of liver disease, a liver biopsy was performed and histology revealed glycogenosis. Glycogenic hepatopathy is characterized by abnormal glycogen accumulation in hepatocytes. It is a reversible condition, with good glycemic control, and is not known to prog- ress to fibrosis. This entity should be distinct from other causes of hepatomegaly and elevated liver enzymes, in diabetic patients, such as nonalcoholic fatty liver disease. Although glycogenic hepatopa- thy is a major cause of hepatomegaly in type 1 diabetes mellitus, is rare and likely under-recognized, the diagnosis has implications in the management and outcome. Keywords: Glycogenic hepatopathy; Diabetes mellitus; Hepato- megaly Introduction In the clinical setting of diabetes, hepatomegaly can be caused by hepatic glycogenosis or nonalcoholic fatty liver disease (NAFLD) [1]. Glycogenic hepatopathy (GH) is a rare and under-recog Continue reading >>
Liver Manifestation Of Poorly Controlled Type 1 Diabetes Mellitus: Hepatic Glycogenosis
Liver manifestation of poorly controlled Type 1 diabetes mellitus: hepatic glycogenosis Serkan Yener1, Erdener Ozer2, Ozlem Yuce1, Firat Bayraktar1 & Sena Yesil1 1Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey; 2Department of Pathology, Dokuz Eylul University, Izmir, Turkey. We report an 18 years old female with hepatomegaly and elevated liver function tests. She had been diagnosed with Type 1 diabetes mellitus when she was 13 years old. She was referred to our division because of diabetic ketoacidosis. Evaluation of her previous records revealed the presence of liver function abnormalities for 4 months. At physical examination she had an enlarged liver. A1c level was 13%. She was treated initially with intravenous insulin. Following the achievement of acceptable plasma glucose levels, negative urinary ketone bodies and normal bicarbonate levels, insulin detemir and insulin aspart were suggested. Ultrasonography revealed the presence of hepatomegaly with 200 mm longitudinal axis. Viral hepatitis markers including hepatitis B, hepatitis C and CMV, ANA and AMA were negative. Serum alpha-1 AT, ceruloplasmin, copper, iron and ferritin levels were in normal ranges. Liver biopsy revealed glycogen deposition that was consistent with hepatic glycogenosis. Subsequent to the achievement of glycemic control, liver enzymes started to decline and 50% reduction was achieved in ALT in 1 week. Hepatic glycogenosis is associated with poor metabolic control and high amount of insulin that is required to maintain euglycemia. Hepatic glycogenosis may resolve following glycemic control. Continue reading >>
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Non-alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) is the generic term used to describe conditions that cause fat to build up within the liver. It is a common disease that often occurs in people who are overweight or obese, including those with type 2 diabetes. How serious is non-alcoholic fatty liver disease? For most people, having small amounts of fat in the liver cells usually causes no problems. But for others, the build-up of liver fat can lead to serious health problems. NAFLD, in particular, increases the risk of cardiovascular issues such as heart attack and stroke, which makes it particularly dangerous for people with type 2 diabetes who already have a greater risk of cardiovascular disease. I have diabetes, how do I avoid non-alcoholic fatty liver disease? Lowering the risk of non-alcoholic fatty liver disease is generally a matter of gradual weight loss and maintaining regular exercise. This also helps to lower the risk of cardiovascular problems. What is the function of the liver? The liver helps to store fuel (glycogen) made from sugars, breaking it down and releasing it to the bloodstream. Fats and proteins are processed and toxins are removed by the liver. Bile, which breaks down the fat in foods, is also created by the liver. What are the stages of NAFLD? Non-alcoholic fatty liver disease (NAFLD) can be broken down into four different stages: Stage 1: Steatosis (simple fatty liver) Steatosis is where there is excess fat in the liver but not to an extent to cause symptoms to appear. As a result, fatty liver disease is often not picked up until a later stage. Stage 2: Non-alcoholic steatohepatitis (NASH) Steatohepatitis (NASH) occurs if the liver becomes damaged causing it to become inflamed. Symptoms such as a pain in the top right of your abdomen may be felt at Continue reading >>
Improper Insulin Compliance May Lead To Hepatomegaly And Elevated Hepatic Enzymes In Type 1 Diabetic Patients
We have encountered hepatomegaly and pronounced elevation of liver enzymes AST and ALT in four patients with type 1 diabetes. These patients shared similar clinical features. They were all female (aged 11–14 years) with poor glycemic control. All had frequent hyperglycemia and intermittent hypoglycemia related to their history of poor compliance. Most of them had multiple hospital admissions for severe hyperglycemia and/or diabetic ketoacidosis. In addition to their high daily doses of insulin (1.3–2.2 units · kg−1 · day−1), most were receiving extra doses of insulin to correct their frequent hyperglycemia. A1C levels were all higher than normal (ranging from 9.2 to 14.5%). Their initial AST and ALT levels were at least 30- and 14-fold higher than the normal limits, respectively, but the other liver function tests, such as alkaline phosphatase, prothrombin/partial prothrombintime, and total bilirubin, were normal except for one patient who had a minimal increase in alkaline phosphatase and total billirubin. The degree of hepatomegaly did not correlate with the liver enzyme levels, nor did it correlate with glycemic control or HbA1c levels. Upon admission to the hospital, proper insulin dosing was established. Three of the four patients were able to lower their insulin dose to 0.9–1.2 units · kg−1 · day−1 and achieve normal glycemic control. The AST and ALT levels were quickly decreased in just a few days after the patients obtained better glycemic control during hospitalization. Except for one patient, who was admitted for diabetic ketoacidosis, the patients had no apparent symptoms of liver disease before the admission. Their hepatomegaly was an incidental finding. Other than poorly controlled diabetes, the investigations did not reveal any other caus Continue reading >>
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How Does Diabetes Affect The Liver?
Liver disease may occur as a result of diabetes, and the reverse is true as well. Non-alcoholic liver disease may also be caused by obesity, protein deficiency, HIV infection and exposure to toxic chemicals. Drugs such as corticosteroids, tamoxifen and estrogens also may damage the liver. Diabetics who have concurrent hepatitis C infection are at high risk of complications. Video of the Day The liver plays a role in glucose regulation. Glucose is transported from the intestines to the liver, which stores it as glycogen or uses it for fuel. Insulin receptors in fat, liver, and muscle cells facilitate the use of glucose. Insulin regulates the entry of glucose into tissues and promotes glycogen storage. Insulin is metabolized in the liver, where it promotes the production of glycogen, protein, cholesterol, and triglycerides and stimulates the formation of low density lipoproteins, or LDL, which transport cholesterol into the arteries. In diabetes, excessive output of glucose by the liver contributes to elevated fasting blood sugars. Fat accumulation in the liver may be linked to excess glycogen, which is common among diabetics. Fatty deposits may be due to the increased transport of fat to the liver from the intestines or to decreased removal of fat from the liver. The condition occurs secondary to obesity as well as diabetes, but the exact reasons are unknown. The National Institute of Diabetes and Digestive and Kidney Disease reports that 10 to 20 percent of Americans have fatty liver. Diagnosis may depend on blood work, CT scan or ultrasound imaging and biopsy. Although there may be no symptoms, an enlarged liver and enzyme abnormalities are characteristic of fatty liver. The condition may also cause abdominal pain, nausea and vomiting, or--rarely--fluid accumulation ar Continue reading >>
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 >>
Why You Should Know About Fatty Liver Disease
Non-alcoholic fatty liver disease can be a problem for people with diabetes, especially type 2 diabetes. Learn more about this growing condition. Fatty liver disease is an “underappreciated problem that seems to be getting worse,” according to Mitch Lazar, MD, PhD, chief of the division of endocrinology, diabetes and metabolism at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. For many years physicians believed that fatty liver was a benign condition but in 1980 non-alcoholic fatty liver disease (NAFLD) was designated a real condition. “Fortunately with increasing knowledge and research on the disease, there is a growing awareness,” says Dina Halegoua-Demarzio, MD, director of the Fatty Liver Center at Thomas Jefferson University Hospital, also located in Philadelphia. “More awareness of the problem in doctors and patients will enable early intervention that can prevent cirrhosis, liver failure and liver cancer.” It’s a particular issue for people with type 2 diabetes. Up to 70 percent of obese type 2 diabetes patients have fatty livers, meaning at least five percent of liver cells show evidence of fat. Although fatty livers are benign and estimates vary considerably, about five to 10 percent of people with the condition will go on to develop the more serious non-alcoholic steatohepatitis (NASH) that causes inflammation, scarring and damage to the liver cells. 1 Fatty livers can also start a cascade of serious damage to the liver and attempts by the organ to regenerate itself that culminate in an abundance of scar tissue and impaired liver function. It has also been linked to increased risk of heart attack and stroke.2 Studies show that anywhere from three to 26 percent of people with NASH will progress to cirrhosis, whi Continue reading >>
Full Text - Glycogen Hepatopathy In Children With Poorly Controlled Type 1 Diabetes - International Journal Of Case Reports And Images (ijcri)
Glycogen hepatopathy in children with poorly controlled type 1 diabetes Hanh T. D. V1,Genna W. Klein2,Anthony Loizides3,Ping Zhou2,Qiang Liu4,Debra H. Pan3 1Department of Pediatrics, Bronx-Lebanon Hospital Center, Bronx, NY, United States. 2Division of Pediatric Endocrinology, Department of Pediatrics, The Childrens Hospital at Montefiore, Bronx, NY, United States. 3Division of Pediatric Gastroenterology, Department of Pediatrics, The Childrens Hospital at Montefiore, Bronx, NY, United States. 4Department of Pathology, The Childrens Hospital at Montefiore, Bronx, NY, United States. Vo HTD, Klein GW, Loizides A, Zhou P, Liu Q, Pan DH. Glycogen hepatopathy in children with poorly controlled type 1 diabetes. International Journal of Case Reports and Images 2011;2(9):1-4. Introduction:Glycogen hepatopathy has been described in children with poorly controlled type 1 diabetes. Diabetic patients with hepatomegaly and abnormal liver enzymes have often been assumed to have non-alcoholic steatohepatitis rather than glycogen hepatopathy. It is important to recognize and distinguish glycogen hepatopathy from non- alcoholic steatohepatitis as it impacts the management and long-term prognosis. Case Series:We describe four cases of children with poorly controlled type 1 diabetes mellitus who developed glycogen hepatopathy, and review the available literature. Conclusion:Pediatricians should raise awareness of this potentially reversible liver complication in children with poorly controlled T1DM. It has been suggested that diabetic patients with hepatomegaly and elevated liver enzymes be given a trial of improved glycemic control prior to more invasive investigation. Key Words: Children, Hepatomegaly, Diabetes, Glycogen hepatopathy Type 1 diabetes (T1DM) is a common pediatric endocrin Continue reading >>
Type 1 Diabetes
Type 1 diabetes (insulin dependent diabetes, juvenile) is a condition in which the body stops making insulin. This causes the person's blood sugar to increase. There are two types of diabetes, type 1 and type 2. In type 1 diabetes, the pancreas is attacked by the immune system and then it cannot produce insulin. In type 2 diabetes the pancreas can produce insulin, but the body can't use it. Causes of type 1 diabetes are auto-immune destruction of the pancreatic beta cells. This can be caused by viruses and infections as well as other risk factors. In many cases, the cause is not known. Scientists are looking for cures for type 1 diabetes such as replacing the pancreas or some of its cells. Risk factors for type 1 diabetes are family history, introducing certain foods too soon (fruit) or too late (oats/rice) to babies, and exposure to toxins. Symptoms of type 1 diabetes are skin infections, bladder or vaginal infections, and Sometimes, there are no significant symptoms. Type 1 diabetes is diagnosed by blood tests. The level of blood sugar is measured, and then levels of insulin and antibodies can be measured to confirm type 1 vs. type 2 diabetes. Type 1 diabetes is treated with insulin and lifestyle changes. Specifically, meal planning to ensure carbohydrate intake matches insulin dosing. Complications of type 1 diabetes are kidney disease, eye problems, heart disease, and nerve problems (diabetic neuropathy) such as loss of feeling in the feet. Poor wound healing can also be a complication of type 1 diabetes. Type 1 diabetes cannot be prevented, however, keeping blood sugar at healthy levels may delay or prevent symptoms or complications. There is currently no cure, and most cases of type 1 diabetes have no known cause. The prognosis or life-expectancy for a person with Continue reading >>
Glycogenic Hepatopathy In Type 1 Diabetes Mellitus
Copyright © 2015 Murat Atmaca et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Glycogenic hepatopathy is a rare cause of high transaminase levels in type 1 diabetes mellitus. This condition, characterized by elevated liver enzymes and hepatomegaly, is caused by irreversible and excessive accumulation of glycogen in hepatocytes. This is a case report on a 19-year-old male case, diagnosed with glycogenic hepatopathy. After the diagnosis was documented by liver biopsy, the case was put on glycemic control which led to significant decline in hepatomegaly and liver enzymes. It was emphasized that, in type 1 diabetes mellitus cases, hepatopathy should also be considered in the differential diagnoses of elevated liver enzyme and hepatomegaly. 1. Introduction Liver enzyme elevation is more common among diabetic patients compared to the general population. This condition is often associated with nonalcoholic hepatosteatosis [1, 2]. Another very rare cause of elevated liver enzymes, especially among type 1 diabetic patients, is glycogenic hepatopathy (GH). GH develops due to excessive and irreversible accumulation of glycogen in the hepatocytes and causes liver function disorders and hepatomegaly [3, 4]. Mauriac first defined GH in a child with brittle diabetes, as a component of Mauriac syndrome, characterized by delayed development, hepatomegaly, cushingoid appearance, and delayed puberty [5]. Additionally, GH can also be observed in adult type 1 diabetic individuals without other components of Mauriac syndrome [6–8]. Hyperglycemia and overinsulinization (poor glycemic control) are believed to be Continue reading >>
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Prevalence Of Hepatopathy In Type 1 Diabetic Children
Abstract The Prevalence of liver disease among diabetics has been estimated to be between 17% and 100%. Most of these data were obtained from adult studies. The aim of our study was to screen for liver disease among type 1 diabetic children. Methods Children with type 1 diabetes following in clinic have been examined for existence of liver disease, from November 2008 to November 2009. All were subjected to the following: History, physical examination, liver function tests, fasting lipid profile, HbA1C, and ultrasound of the liver. A hyperechogenic liver and/or hepatomegaly on ultrasound were attributed most likely to excess glycogen or fat in the liver, after negative extensive work-up to rule out other underlying liver disease. 106 children with type 1 diabetes were studied: age ranged between 8 months to 15.5 years, sixty two patients were females. Twenty two patients (21%) were identified to have abnormal findings on ultrasound of the liver: 10 patients had hepatomegaly and 12 had hyperechogenic liver. The group with hyperechogenic liver had poorer glycemic control than patients with normal liver (Mean HbA1c 12.14% Vs 10.7%; P value = 0.09). Hyperechogenic liver resolved in 60% at 6 months follow-up upon achieving better glycemic control. Hyperechogenic liver and/or hepatomegaly are not uncommon in children with type 1 diabetes and tend to be more prevalent among children with poor glycemic control. Type 1 diabetes related hepatopathy is reversible by optimizing glycemic control. Because of its safety, and reliability, ultrasound can be used to screen for hepatopathy in type 1 diabetic child. Background Type 1 diabetes is a disorder of glucose metabolism that results from insulin deficiency secondary to autoimmune destruction of insulin-secreting β-cells. The preval Continue reading >>
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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 >>
