Having Diabetes Can Increase Your Risk of Liver Disease—Here's What to Do to Help

Odds are you know someone who has diabetes, a metabolic disorder that affects 37.3 million Americans, according to the American Diabetes Association. Having diabetes increases your risk of developing other diseases, such as heart disease. One complication of diabetes that’s often overlooked, though, is metabolic dysfunction-associated steatotic liver disease (MASLD), which was formerly known as nonalcoholic fatty liver disease, or NAFLD. (For this article, we will refer to it as NAFLD, since that is what the ADA uses in their most current Standards of Care in Diabetes.)

Related: 4 Science-Backed Ways to Keep Your Liver Healthy

These two diseases are linked, as having diabetes increases your risk of liver disease, and liver disease increases your risk of diabetes, according to the Centers for Disease Control and Prevention. About 70% of people who have obesity and type 2 diabetes are estimated to have liver disease, says the ADA. That’s why it’s critical to understand the connection between the two diseases and learn how to keep your liver healthy. Keep reading to discover what you need to know.

The Link Between Diabetes and Fatty Liver Disease

The liver is an important organ that plays a role in digestion, blood sugar regulation and toxin removal, among other functions, per Johns Hopkins Medicine. It can become damaged by elevated blood sugars, which promote fat accumulation. The key contributor to both is insulin resistance. “Insulin resistance is the root cause of both NAFLD and type 2 diabetes,” says Peggy Kraus, M.A., CDCES, a registered clinical exercise physiologist and certified diabetes care and education specialist with Peggy Kraus Coaching.

Insulin is a hormone that acts like a gatekeeper: it opens the cell to push glucose from the bloodstream in where it can be used for energy. Insulin also helps the liver store glucose. When a person has insulin resistance, the cells resist the insulin the body is making. As a result, the pancreas is forced to make more insulin to help move glucose out of the blood and normalize blood sugar. Over time, the pancreas can’t keep up with this demand for insulin, which can lead to high blood sugar levels and the development of prediabetes or type 2 diabetes.

Genes, older age and lifestyle factors, such as being sedentary and having overweight or obesity, are key contributors to insulin resistance, states the ADA. Insulin resistance plays a role in NAFLD by increasing the release of free fatty acids and storing them in the liver, promoting fat accumulation in the organ.

Both diabetes and liver disease share similar risk factors, such as elevated blood sugar, obesity, high cholesterol and a higher-fat and -sugar diet, says Washington, D.C.-based registered dietitian and diabetes expert Caroline Thomason, RD, CDCES. That’s why many of the same things you can do to promote liver health also can help manage diabetes.

6 Things You Can Do to Protect Your Liver 

1. Get Screened

You won’t know if you have NAFLD, because there are typically no symptoms during the early stages of disease, says the CDC. That’s why the CDC urges asking your doctor if you should be screened for NAFLD. This is done by measuring liver enzymes via a blood test. Additional testing, such as imaging, may be needed. The earlier you’re diagnosed, the more likely it is that lifestyle interventions can help manage fatty liver.

2. Manage Your Blood Sugar

Long-term blood sugar elevation can damage your liver. Therefore, being confident in your diabetes treatment plan is key. Ask your doctor to review your medication to make sure the regimen you’re on is optimized and working for you. Connect with a registered dietitian who can help determine the best nutrition and lifestyle changes for you to help regulate your blood sugar.

Related: 12 Healthy Ways to Lower Your Blood Sugar

3. Maintain a Healthy Weight 

Losing weight is not simple, but it is an important factor to consider for people with diabetes who have overweight or obesity and have large amounts of visceral fat (fat around the waistline), which is a risk factor for developing NAFLD. The National Institute of Diabetes, Digestive and Kidney Diseases points out that weight loss can reduce fat, inflammation and scarring (caused by excess fat) in the liver. Aim to lose weight slowly: the NIDDK says that rapid weight loss can make liver disease worse. A good goal is to lose 7% to 10% of your body weight. Wondering how to get started? Check out these Weight-Loss Meal Plans that can help you approach weight loss in a healthy, sustainable way. If that feels like too much, try focusing on one or two lifestyle changes at a time, such as getting in a walk most days or cooking more meals at home.

4. Move More

People with diabetes are encouraged to exercise for a minimum of 150 minutes of moderate-intense physical activity per week, says the CDC. “Aerobic exercise and resistance training help to slim the waistline and improve insulin sensitivity. As cells become more sensitive to insulin, insulin resistance improves, and so does NAFLD,” says Kraus.

There are so many good things that happen to your body when you exercise 30 minutes every day. If you are not a regular exerciser, start slowly and increase gradually. Find an activity you love and want to do. Take breaks during the day to stand up and stretch, march in place or get in a quick walk.

5. Eat a Low-Fat, High-Fiber Diet 

Fiber is a nutrient with big health benefits, including reducing cholesterol, blood sugar and body fat, all of which help decrease your risk of NAFLD, says Thomason. Aim to eat 28 to 34 grams per day. Some simple strategies include consuming fruits or vegetables at every meal, making half of your grain intake whole grains and opting for a serving of nuts or seeds daily. “Concentrate on fruits, vegetables, beans and lentils, which are naturally high in fiber and low in fat,” says Kraus. 

6. Reduce Sugar Intake 

Foods that are calorically dense and easy to overconsume, such as foods high in added sugar and fat, can result in excess calories that lead to weight gain. “One of the biggest contributors to NAFLD is overconsumption of calories,” Thomason says. The Mediterranean style of eating is a great place to start to reduce sugar and eat more whole foods. And it has some of the best evidence for improving liver function and cardiometabolic health, according to the ADA’s Standards of Care in Diabetes.

The Bottom Line 

Having diabetes does not mean you’re destined to develop liver disease. According to the CDC, healthy lifestyle changes may help to prevent, slow down or reverse the buildup of extra fat in your liver. In addition, managing your diabetes through a healthy diet, physical activity and taking medication as prescribed can also reduce the risk of NAFLD. For help reaching your goals, talk to a registered dietitian or a certified diabetes care and education specialist for support.