Effect of Diabetes on Hepatocytes

Diabetes is a chronic metabolic disorder characterized by abnormally high levels of glucose in the blood. Normally, your pancreas produces a hormone called insulin in response to the ingestion of food and consequent increases in blood glucose. Insulin helps the glucose enter cells for use as energy for the functioning of the cell. In type 1 and type 2 diabetes, this mechanism is disrupted. The high blood glucose brought about by insulin resistance which is characteristic of type 2 diabetes has an effect on the cells of your liver, or hepatocytes, which can lead to serious consequences.

Diabetes Types

• Type 1 diabetes can affect children and young adults up to the age of around 35. The pancreas makes little or no insulin, leading to the characteristic high blood glucose levels. These patients are managed with daily insulin injections.

  Type 2 diabetes mainly affects adults over 40, but it increasingly affects children and young adults. It is characterized by insulin resistance meaning that for some reason, your body cells cannot use insulin to metabolize glucose for energy, corresponding in high glucose levels in your blood. It is managed by diet, drugs to lower blood sugar and exercise. It is type 2 diabetes that is more commonly associated with effects on hepatocytes.

Effect on Hepatocytes

• Hepatocytes make up 70 to 80 percent of the mass of your liver and are responsible for the metabolism of proteins, lipids, carbohydrates and for detoxification. The insulin resistance characteristic of type 2 diabetes leads to changes in the way in which your liver carries out its usual functions. As a consequence, there is an increase in the uptake and storage of triglyceride fats from your diet, abdominal fat and nearby muscles into compartments within the hepatocytes called vesicles. This infiltration of fat is called steatosis. The result is a fatty liver, which is larger than normal.

Consequences

• Steatosis is harmless or benign and is the beginning of a spectrum of fatty liver disease called non-alcoholic fatty liver disease or NAFLD. A small proportion of these patients will go on to develop inflammation of the liver or hepatitis--so the condition progresses to what is known as steatohepatitis or non-alcoholic steatohepatitis, referred to as NASH. This can lead to the hepatocytes becoming damaged, sometimes even leading to their death, called hepatocellularnecrosis.

Complications

• If your liver cells become damaged by inflammation, which can occur in response to the fat infiltration, scar tissue builds up as part of the healing process. There is a possibility that this can lead to irreversible liver scarring, or cirrhosis of the liver. Importantly, a case report in the Obesity Surgery journal states that since cirrhosis is a possible consequence of untreated NASH, hepatocellular carcinoma--liver cancer--could be the end result of this condition.

Diagnosis and Treatment

• Most of the time, there are little or no symptoms of steatosis. It tends to be discovered during routine checks for other things, where the attending physician may notice that you have an enlarged liver, for example, during a scan. If it is suspected, a biopsy is taken--this is where a very slim needle is inserted into your abdomen under a local anesthetic. If steatosis is discovered, the best treatment is to ensure that the underlying cause is managed successfully. In the case of diabetes, this would involve you adhering to medications to reduce blood sugar and maintaining a healthy weight through diet and exercise.

Serious Consequences

• If steatosis is not treated early and the condition is allowed to progress to severe cirrhosis, you may need a liver transplant. The success rate in most transplant centers is about 90 percent. In the case of hepatocellular carcinoma, however, the prognosis is not so good. If the cancer can not be properly taken out during surgery, death usually occurs within three to six months.