How Does Cirrhosis Affect Type 2 Diabetes?

Mary Pickett, M.D., is a lecturer for Harvard Medical School and an assistant professor of medicine at Oregon Health & Science University in Portland, OR. At OHSU, she practices general internal medicine and teaches medical residents and students.

Question:

My 75-year-old father has cirrhosis of the liver due to alcoholism. He also has type 2 diabetes. How will the cirrhosis affect his diabetes?

Answer:

The combination of chronic liver disease and diabetes can present extra challenges. "Cirrhosis of the liver" is the term used to describe a badly scarred liver that is failing in its basic functions.

Among the basic functions of the liver are storing up of extra sugar and releasing this sugar overnight or in the case of emergency "lows." When the liver doesn't perform these functions, someone with diabetes can be vulnerable to low blood sugars. This means that tight control of sugar may not be safe or easily managed in a person with advanced liver disease. Your doctor may choose higher goals for glucose and hemoglobin A1C tests.

Liver disease requires you to avoid certain medicines that are used for diabetes treatment. The "glitazone" drugs such as pioglitazone (Actos) and rosiglitazone (Avandia) can't be used. "Statin" cholesterol-lowering medicines should be avoided or used with great caution in people who have liver disease.

A person with cirrhosis has a higher risk for complications such as renal disease and neuropathy.

Liver disease that has progressed to an advanced stage can interfere with your thinking, causing periods of confusion. This is called "encephalopathy." These periods of confusion can make it difficult for a person to keep up with diabetes medicines and other treatment.