By naturopath Margaret Jasinska

What does the liver have to do with diabetes? A great deal. Having an unhealthy liver can predispose you to developing type 2 diabetes. If you already have diabetes, this can take a significant toll on your liver. When thinking about diabetes, most people are concerned about their kidneys. This is a valid concern, but please also pay attention to your liver.

Did you know that diabetics are 50% more likely to develop liver disease? Particularly fatty liver disease. Most people and most doctors don’t take fatty liver seriously enough. It should be taken seriously. It isn’t a trivial matter. Left untreated, fatty liver can progress to serious liver damage.

Fatty liver disease is incredibly common in overweight people; nearly everyone with excess weight on their abdomen has some degree of fatty liver. 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 and heart disease, but you may not realise diabetes has terrible effects on the liver.

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.  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, inside arteries and as general body fat stores.  As insulin levels become higher and higher, insulin loses its ability to control blood sugar levels.  Therefore the blood sugar level creeps upwards, eventually getting high enough to qualify as diabetes.

Whenever you eat carbohydrate containing foods, your body digests them and breaks them down into sugar.  All foods contain some carbohydrate except animal protein such as meat, fish, chicken, eggs as well as pure fat like oil.  Glucose isn’t of much use to you in your bloodstream; you need it inside your cells where it can be used for energy.  It is the job of insulin to transport the glucose from your bloodstream into your cells.

People with insulin resistance lose the ability to do that, therefore they crave foods high in carbohydrate (such as sugar, bread, pasta) and feel weak, hungry, tired or irritable if they don’t eat these foods regularly.  Because their body cannot use carbohydrate efficiently for energy, these carbohydrate rich foods are converted into fat instead.  The vast majority of diabetics have a fatty liver.  You do not need to be overweight to have a fatty liver; the condition is very common in slim people.

If you have diabetes, you are probably well aware that you require regular blood tests to check on the health of your kidneys and your heart.  You probably have regular eye exams and foot examinations; however it is not standard practice to offer diabetics liver exams.  This is very unfortunate because there is very little that can be offered to a person who has developed severe liver disease other than liver transplantation.

The authors of this study recommend that every diabetic has a blood test and ultrasound to check on the health of their liver annually.  The blood test would check the levels of liver enzymes (to test for inflammation and damage to liver cells) and the ultrasound would check for the presence of fat accumulation.  A CT scan and liver biopsy may be required in cases of advanced liver disease.