The Relationship Between Blood Sugar Levels and Fatty Liver in Diabetes

The relationship between blood sugar levels and fatty liver in diabetes

In the last few years, the number of patients with diabetes and fatty liver has increased significantly across the world. People who live with diabetes face a variety of health challenges, and the relationship between blood sugar levels and the development of fatty liver is a most ignored factor among them. Many people do not realize that they have this disease at the right time because the symptoms of fatty liver disease appear very late. According to (Journal of Hepatology, 2023), the prevalence of NAFLD in patients with type 2 diabetes ranges from 34% to 71% in different studies.

Understanding Blood Sugar Levels

To understand the connection between diabetes and fatty liver, it’s essential to understand normal blood sugar levels first. The normal blood glucose level should be less than 99 mg/dL (5.5 mmol/L) in fasting condition and less than 140 mg/dL (7.8 mmol/L) in non fasting condition. In individuals without diabetes, the body efficiently regulates blood sugar to maintain balance. Diabetes breaks this balance, leading to elevated blood sugar levels. High blood glucose level is called hyperglycemia and low blood glucose level  is called hypoglycemia. The amount of sugar in the blood increases due to insulin resistance, which is the reason for the accumulation of excess fat in the body and liver.

Cartoon image of a fatty liver and hand written diabetes word as a symbol of The Relationship Between Blood Sugar Levels and Fatty Liver in Diabetes

Fatty Liver in Diabetes

Fatty liver, which is characterized by the presence of excess fat in the liver cells. It is very common in people with diabetes. The interaction between diabetes and fatty liver involves complex mechanisms, and exploring these connections is very important to managing both conditions successfully. When someone lives with uncontrolled diabetes for a long time, the excess glucose in the blood gradually accumulates as fat in the body and liver, which is undetectable in the early stages. Because the symptoms of fatty liver appear late, in many cases it is caught after it reaches a very complicated stage.

Causes and Mechanisms

Fatty liver disease, specifically non alcoholic fatty liver disease (NAFLD), is a common complication of diabetes, particularly in cases with  type 2 diabetes.The development of fatty liver disease in diabetes is a complex interaction of several factors mainly caused by insulin resistance.

Here’s a breakdown of the key causes and mechanisms:


  • Insulin resistance: This is the main culprit. In diabetes, cells become less responsive to insulin, resulting in elevated blood sugar levels and increased free fatty acid (FFA) release from adipose tissue. These FFAs get dumped into the liver, overloading its ability to process and export them, leading to fat accumulation.
  • Increased de novo lipogenesis: Insulin resistance also stimulates the liver to produce its own fat (triglycerides) from other sources like carbohydrates and amino acids, further contributing to the fat overload.
  • Impaired fatty acid oxidation: Normally, the liver burns FFAs for energy. However, insulin resistance interferes with this process, leaving more fat to accumulate.
  • Reduced VLDL secretion: VLDL (very low-density lipoprotein) transports triglycerides from the liver to other tissues. In diabetes, impaired VLDL secretion due to insulin resistance leads to further build-up of fat in the liver.
  • Genetic predisposition: Some individuals have a genetic susceptibility to developing NAFLD, making them more prone to fatty liver in the presence of other risk factors like diabetes.


  • Metabolic stress: The combined effects of insulin resistance, elevated blood sugar, and increased FFAs create a metabolic stress environment in the liver. This causes an inflammatory response, oxidative stress and cell damage, which contributes to the progression of fatty liver disease and can lead to more severe liver diseases such as cirrhosis.
  • Gut dysbiosis: Recent research suggests an altered gut microbiome composition in some patients with NAFLD and diabetes. This microbiome imbalance might further contribute to metabolic dysfunction and promote the development of fatty liver.

Symptoms and Diagnosis

Here we’ll discuss the symptoms and diagnosis of both conditions separately.

Symptoms of diabetes:

  • Excessive thirst and urination: The body tries to flush out excess sugar through urine, leading to frequent urination and increased thirst.
  • Unexplained weight loss: When the body can’t use glucose for energy, it starts breaking down muscle and fat for fuel, causing weight loss.
  • Fatigue: Chronic high blood sugar levels can zap your energy, leaving you feeling constantly tired.
  • Blurred vision: High blood sugar can damage blood vessels in the eyes, leading to blurry vision.
  • Slow-healing wounds: Diabetes can impair blood circulation, making it harder for wounds to heal.
  • Tingling or numbness in hands and feet: High blood sugar can damage nerves, causing tingling or numbness in the extremities.

Diagnosis of diabetes:

  • HbA1c test: This blood test measures average blood sugar levels over the past 3 months.
  • Fasting blood sugar test: This test measures blood sugar levels after not eating or drinking anything for at least 8 hours.
  • Random blood sugar test: This test can be done at any time and measures blood sugar levels without regard to fasting.

Symptoms of fatty liver disease:

  • Fatigue and exhaustion: This is a common symptom, but it can also be caused by other conditions.
  • Pain or discomfort in the upper right abdomen: This is where the liver is located, so pain in this area could be a sign of fatty liver disease.
  • Unexplained weight loss: Similar to diabetes, weight loss can occur when the body is unable to use glucose for energy and starts breaking down fat stores.
  • Yellowing of the skin and eyes (jaundice): This is a sign of severe liver damage and requires immediate medical attention.


  • Blood tests: Liver function tests can detect elevated levels of certain enzymes that indicate liver damage.
  • Imaging tests: Ultrasound, CT scan, or MRI can be used to look for fat buildup in the liver.
  • Liver biopsy: In some cases, a liver biopsy may be necessary to confirm the diagnosis of fatty liver disease.

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Prevention Strategies

Preventing the progression of fatty liver in diabetes involves effective blood sugar control. A healthy lifestyle, including a balanced diet and regular exercise, can go a long way in reducing the risk of  fatty liver complications.

Here are some prevention strategies:

  • Weight Management: Aim for 7-10% weight loss through a balanced diet and regular exercise. Losing weight improves insulin sensitivity and reduces fat accumulation in the liver.
  • Diet: Choose a Mediterranean-style diet rich in fruits, vegetables, whole grains, and lean protein. Reduce or stop(if possible) processed foods, sugary drinks, saturated and unhealthy fats.
  • Exercise: Engage in at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity per week. Regular physical activity increases glucose absorption, increases insulin sensitivity and improves fat burning.
  • Alcohol Moderation: Excessive alcohol consumption can directly damage the liver and worsen both conditions. Limit alcohol intake to moderate levels if you choose to drink.
  • Sleep Hygiene: Try to cover 7-8 hours of quality sleep each night. Poor sleep disrupts insulin regulation and increases inflammation, contributing to diabetes and NAFLD.
  • Stress Management: Chronic stress releases cortisol, which further hinders insulin sensitivity and promotes fat storage. Manage stress through relaxation techniques like yoga, meditation, or spending time in nature.
  • Know your family history: Familiarity with your family’s health can alert you to potential genetic risks for both conditions.
  • Regular checkups: Regular monitoring of blood sugar and liver function tests allows for early detection and intervention.
  • Seek professional guidance: Consult a registered dietitian or healthcare professional for personalized diet and exercise plans.

You can remarkably reduce your risk of developing both diabetes and fatty liver disease and improve your overall health by maintaining a healthy lifestyle.

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FAQ’s About The Relationship Between Blood Sugar Levels and Fatty Liver in Diabetes

How does a fatty liver affect blood sugar levels?

Fatty liver, specifically non-alcoholic fatty liver disease (NAFLD), can worsen blood sugar control in several ways:

  • Insulin resistance: The fat buildup in the liver reduces its ability to respond to insulin, leading to higher blood sugar levels.
  • Increased inflammatory markers: Fatty liver triggers inflammation, which can further impair insulin sensitivity and contribute to high blood sugar.
  • Altered glucose metabolism: NAFLD can disrupt the liver’s role in storing and releasing glucose, potentially leading to blood sugar fluctuations.
What is the relationship between diabetes and the liver?

The relationship is bi-directional:

  • Diabetes increases fatty liver risk: High blood sugar and insulin resistance, characteristic of diabetes, can promote fat accumulation in the liver, leading to NAFLD.
  • NAFLD worsens diabetes control: As mentioned above, fatty liver can further impair insulin sensitivity and glucose metabolism, making diabetes management more challenging.
How do diabetics treat fatty liver disease?

The primary treatment for fatty liver in diabetics is lifestyle modification:

  • Weight loss: Even a modest weight loss of 5-10% can significantly improve both diabetes and NAFLD.
  • Healthy diet: Choose a Mediterranean-style diet rich in fruits, vegetables, whole grains, and lean protein. Limit processed foods, sugary drinks, and unhealthy fats.
  • Regular exercise: Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity per week.
  • Alcohol moderation: Limit alcohol intake or abstain entirely, as alcohol can further damage the liver.

In some cases, medications may be necessary to manage diabetes or specific complications of NAFLD. Consult your doctor for personalized treatment recommendations.

How does sugar affect fatty liver disease?

Excessive sugar intake is a major risk factor for both diabetes and NAFLD. Sugar:

  • Contributes to weight gain and obesity, known risk factors for fatty liver.
  • Increases insulin resistance, leading to both high blood sugar and fat accumulation in the liver.
  • Triggers inflammatory responses that can worsen NAFLD.

Therefore, reducing sugary drinks, processed foods, and refined carbohydrates is crucial for managing both conditions.

Does fatty liver cause low blood sugar?

No, fatty liver itself does not typically cause low blood sugar. However, people with both NAFLD and diabetes are at a higher risk of developing hypoglycemia (low blood sugar) due to:

  • Altered glucose metabolism in the liver.
  • Potential interactions between diabetes medications and NAFLD.

It’s essential for diabetics with fatty liver to monitor their blood sugar levels closely and consult their doctor regarding their medication regimen to minimize the risk of hypoglycemia.

FAQ’s About The Relationship Between Blood Sugar Levels and Fatty Liver in Diabetes


In conclusion, the relationship between blood sugar levels and fatty liver in diabetes is intricate but manageable. By understanding the causes, symptoms and effective strategies for prevention, individuals can navigate these conditions with better outcomes. Managing diabetes and fatty liver is a journey that requires commitment to a healthy lifestyle and regular monitoring.
Disclaimer: The information provided in this article is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of content found within this article.

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