The Liver's Role in Blood Sugar Regulation

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The connection between the liver and diabetes is significant and bidirectional, meaning that each condition can increase the risk for, and worsen, the other.

The Liver's Role in Blood Sugar Regulation

The liver is critical for maintaining healthy blood sugar (glucose) levels, acting as both a storage and production facility for glucose.

Glucose Storage: When you eat, the hormone insulin signals the liver to take up excess sugar from the bloodstream and store it as glycogen. This lowers blood sugar.
Glucose Production: When you are fasting or your blood sugar drops (like between meals), the liver breaks down stored glycogen (glycogenolysis) or produces new glucose from other sources like protein and fat (gluconeogenesis). This releases glucose into the blood to keep your levels stable.

In Type 2 diabetes, the liver becomes resistant to insulin's signals. Instead of stopping glucose production after a meal, the resistant liver continues to pump out glucose, contributing significantly to high blood sugar levels (hyperglycemia).

How Diabetes Damages the Liver

Chronic high blood sugar and insulin resistance associated with Type 2 diabetes are major risk factors for liver damage, primarily leading to fatty liver disease.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

This is the most common liver condition seen in people with Type 2 diabetes, affecting up to 70% of diabetic patients. It was formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD).

The progression of liver damage linked to diabetes often follows these stages:

Steatosis (MASLD): Excess fat builds up in the liver cells (more than 5% of the liver's weight). This is linked to the body's impaired fat and carbohydrate metabolism caused by insulin resistance.
Steatohepatitis (MASH): The more serious stage where fat accumulation is accompanied by inflammation, swelling, and liver cell damage. This form was formerly called Non-Alcoholic Steatohepatitis (NASH).
Fibrosis/Cirrhosis: If MASH is left unmanaged, the inflammation causes scarring (fibrosis) of the liver tissue. Severe, permanent scarring is called cirrhosis, which is a leading cause for the need of a liver transplant.
Hepatocellular Carcinoma (HCC): Cirrhosis also raises the risk of developing liver cancer.

Protecting Your Liver When Living with Diabetes

The good news is that the same lifestyle changes that help manage diabetes are also the primary treatment for MASLD and MASH. Early detection and intervention are critical.

To protect your liver health, focus on:

Blood Sugar Management: Work with your healthcare team to keep your blood glucose and HbA1c levels within the target range.
Weight Management: Losing even 5% to 10% of your current body weight can significantly reduce the amount of fat in your liver and improve insulin sensitivity.
Dietary Changes: Eat a healthy diet low in refined carbohydrates and saturated fats, as excess carbohydrates and sugars are often stored as fat in the liver.
Physical Activity: Regular exercise improves your body's ability to use insulin and helps reduce liver fat.
Screening: If you have diabetes, ask your doctor about getting screened for MASLD, as it often progresses without noticeable symptoms. Screening may involve simple blood tests (like the FIB-4 score) or imaging (like a FibroScan).