Diabetes is a chronic metabolic disorder characterized by elevated levels of blood glucose, or blood sugar, due to either insufficient insulin production, ineffective use of insulin by the body, or a combination of both. Insulin is a hormone produced by the pancreas that regulates glucose uptake into cells for energy and helps maintain normal blood sugar levels.
When blood sugar remains high for a long period it can damage internal organs. Recent research shows that Diabetes and the liver are closely connected. Liver plays a central role in regulating blood sugar levels in our body. Insulin is a hormone made by the pancreas which acts as a messenger to alert cells to take up glucose from the blood. But when liver damaged by fat deposits, scarring or cirrhosis, those cells become less responsive to insulin’s signals. Lets understand in detail the role of liver in diabetes.
1. Glucose Regulation and the Liver
Glycogen Storage and Release: The liver stores excess glucose as glycogen after meals, then releases it when blood glucose levels drop. In people without diabetes, insulin tells the liver when to store or release glucose. But in diabetes, insulin signaling is impaired, leading the liver to release glucose even when blood sugar levels are already high.
Gluconeogenesis: The liver can produce glucose from non-carbohydrate sources (like proteins and fats) when needed. In diabetes, especially type 2, gluconeogenesis can become overactive, leading to higher blood glucose levels.
2. Insulin Resistance and Fatty Liver Disease
The liver is crucial for insulin sensitivity, which is the body’s ability to respond to insulin efficiently. Diabetes often involves insulin resistance, where cells in liver, muscles and fat tissues do not respond properly to insulin and lose sensitivity to insulin. It causes the body to produce more insulin to keep blood sugar levels stable. However, as insulin becomes less effective in the liver, it fails to suppress gluconeogenesis (glucose production), leading to elevated blood sugar levels.
Simultaneously, insulin resistance impairs lipid metabolism, causing the liver to accumulate excess fat. This buildup of fat in the liver cells results in fatty liver disease, which can further progress to liver inflammation and scarring. Insulin resistance and non-alcoholic fatty liver disease (NAFLD) are closely linked, creating a vicious cycle that worsens both conditions. Diabetes worsens liver disease so fast that it can progress unnoticed until the appearance of symptoms such as jaundice, fatigue, gastrointestinal bleeding, or abdominal swelling.
3. Lipid Metabolism
The liver helps regulate fat in the bloodstream by producing, processing, and removing triglycerides and cholesterol. Diabetes can lead to an overproduction of triglycerides and LDL cholesterol, raising the risk of heart disease—a common comorbidity of diabetes.
4. Glucagon and Blood Sugar Spikes
Glucagon is a hormone released when blood sugar levels are low, signaling the liver to release glucose. In diabetes, especially type 1, this process can go awry, leading the liver to release too much glucose. This is especially problematic during the night or fasting periods and is a major reason why people with diabetes experience high blood sugar in the morning (a phenomenon known as the “dawn effect”).
5. Inflammation: When fat builds up in the liver, it can trigger a cascade of inflammatory responses, as the body recognizes the excess fat as harmful. Fatty liver leading to inflammation can contribute to insulin resistance and other metabolic disturbances. Chronic inflammation is also linked to various complications associated with diabetes. Promoting liver health can help mitigate inflammation and improve overall metabolic health.
Maintaining liver health is crucial for diabetics as both diseases worsen each other.
1. Balanced Diet
Include whole foods like plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats into your diet. Foods rich in fibre can help improve insulin sensitivity and support liver function.
Reduce the intake of high-sugar and high-fat processed foods, which can contribute to liver fat accumulation and insulin resistance.
Watch portion sizes: Overeating can lead to weight gain and increased fat storage in the liver, so practicing portion control is essential.
2. Regular Physical Activity
Exercising regularly is important for liver health. Around 150 minutes of moderate physical activity each week, along with some strength training exercises is a good idea. Physical activity helps to improve insulin sensitivity and reduce liver fat thereby promoting overall metabolic health.
Stay active throughout the day. Incorporate more movement into your daily routine, such as walking, gardening, or using stairs instead of elevators.
3. Weight Management
Have a healthy weight. Losing excess body weight can help in reducing liver fat and improve liver function. Even a modest weight loss of 5-10% of body weight can have a positive impact on liver health and diabetes management.
4. Hydration
Stay well hydrated. Drinking plenty of water throughout the day helps support liver function and overall health. Proper hydration is essential for metabolic processes and can aid in weight management.
5. Limit Alcohol Intake
Moderate your alcohol consumption if you have alcohol. Excessive alcohol can lead to liver damage and worsen existing liver conditions, particularly in individuals with diabetes.
6. Regular Health Screenings
Monitor liver health. Regular check-ups with your healthcare provider can help monitor liver function through blood tests (such as liver enzyme tests) and assess for any signs of liver disease. Early detection of liver issues is crucial for effective management.
7. Medication Management
If prescribed, take medications for diabetes and any other conditions as directed. Some diabetes medications, like metformin, can positively impact liver health by reducing hepatic glucose production.
8. Avoid Toxins
Be cautious with medications, supplements, and other sources of toxins. Many environment and lifestyle factors can harm the liver. Do consult your doctor before starting any new medication or herbal supplements.
9. Manage Stress
Practice Stress-Reduction Techniques. Stress can negatively impact metabolic health and contribute to unhealthy eating habits. Engage in activities such as mindfulness, meditation, yoga, or deep-breathing exercises to manage stress effectively.
By implementing these strategies, individuals with diabetes can support their liver health, improve insulin sensitivity, and enhance overall metabolic function, ultimately leading to better management of diabetes and a reduced risk of complications.