How Liver Diseases Can Affect Diabetes

     The Feb '99 issue of Clinical Diabetes contained an article 
by Levinthal and Tavil that reviewed how liver diseases can affect 
diabetes.   Among the points they mention:      

 * Diabetes appears to be much more common among people with 
   Hepatitis C and that Hep C may play a role in the cause of
   some types of diabetes. 

 * Interferon treatment for Hepatitis B and Hepatitis C can cause
   high blood sugar levels, requiring increased insulin requirements 
   in insulin-using diabetics.  Interferon therapy has also been  
   implicated in the development of both Type 1 diabetes and Type 2 
   diabetes.  The authors also note a report of a diabetic developing
   severely high triglyceride levels from interferon therapy.

 * Hepatitis B vaccine is effective for most diabetics, but one 
   study that found children with Type 1 diabetes may not respond 
   as well and might benefit from vaccination with 4, rather than 3, 
   injections. 

 * Cirrhosis increases insulin levels, which may suggest insensitivity 
   to insulin, and glucose intolerance is found in at least 80% of 
   people with cirrhosis.  The exact cause of the resistance or 
   insensitivity to insulin among people with cirrhosis is not yet 
   known.   People with cirrhosis may develop fasting hypoglycemia 
   associated with insulin autoantibodies. 

 * People suffering from liver cancer may develop hypoglycemia, 
   perhaps as a result of the liver cancer cell's production of 
   insulin-like growth factor-II (IGF-II).   Diabetics with liver 
   cancer (hepatocellular carcinoma cells) may progressively require 
   less insulin.   Several studies suggest that diabetics are at 
   increased risk for developing primary liver cancer. 

 * People with fulminant liver failure may experience hypoglycemia,
   requiring glucose supplementation. 

 * Several studies have noted increased evidence of diabetes following
   liver transplants, with some estimates of post-transplant diabetes
   occurring in 4-20% of people who undergo liver transplant.   This 
   may be related to use of some drugs used to prevent rejection of 
   the transplanted liver.  The authors note that although diabetes 
   and hepatitis B are both associated with poorer outcomes with kidney 
   transplants, Type 1 diabetics do not appear to be at increased risk
   for organ rejection or patient survival with liver transplant.


    The authors also discuss liver diseases that are coincident with 
diabetes, noting:  
 
 * Hemochromatosis is an inherited condition in which there is 
   excessive absorption and accumulation of iron in the liver and 
   tissues.  The genetic mutation for more than 80% of cases is known.
   Untreated, hemochromatosis can lead to diabetes (known as "bronze 
   diabetes"), progressive liver disease, and cirrhosis, with increased 
   risk for developing primary liver cancer.  About 75% of people with 
   hemochromatosis and cirrhosis have diabetes. 

 * Inherited enzyme deficiencies can cause glycogen storage diseases, 
   in which glycogen may be excessively stored in the liver and is not 
   properly broken down.  An infant born with this condition might 
   require carbohydrate feeding every 2-3 hours to prevent brain damage. 

 * A report of primary biliary cirrhosis (PBC) in a Type 1 diabetic has
   raised the possibility that PBC may be part of the autoimmune 
   polyglandular syndrome.   

 * Primary sclerosing cholangitis (PSC), ulcerative colitis, and
   diabetes may occur in an individual as a genetic autoimmune disease. 
   People with PSC may have more glucose intolerance than people with 
   other liver diseases. 
 
    				- Paula

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[This is a very good article and people interested in the topic should 
read the entire article:   Levinthal GN and Tavil AS, "Liver Disease 
and Diabetes Mellitus." Clinical Diabetes 1999 Feb;17(2).]