First, I would like to introduce the situations that are often encountered in the two jobs. Their liver has more or less some problems. On this basis, diabetes or impaired glucose tolerance are combined.
Xiao Wang, less than 30 years old, is the son of a diabetic patient and often accompanies his mother to see a doctor in the outpatient department. On this day, he came to the outpatient department alone. It turned out that a few days ago, I used my blood glucose meter at home to check and found that my blood sugar was high.
Xiao Wang: Doctor, is there something wrong with the blood glucose meter? How can I get diabetes?
I: I don’t know until I have a physical examination, but it is really possible for you to have a size like yours. Was there any what problem in last year’s physical examination?
Xiao Wang: I have always been so fat. Every year, I have a little fatty liver and high blood lipid, but my blood pressure and blood sugar are always normal.
Me: These are all checked without eating. Have you checked your blood sugar after meals?
Xiao Wang: I haven’t checked it before. I helped my mother check her blood sugar after meals at home that day. I checked it casually…
Lao Li, more than 50 years old, is a chronic hepatitis B patient. Last year, he found that his blood sugar had increased and he had been taking oral hypoglycemic drugs in the outpatient department. His condition was still stable. This time he was hospitalized for liver cirrhosis and found that his blood sugar had obviously increased. After consultation, I decided to give him insulin to control his blood sugar.
Lao Li: Doctor, can you not take insulin? I used to take medicine. Isn’t my blood sugar normal all the time?
Me: Maybe not now. Your liver function is very poor now. Continue to take hypoglycemic drugs or add some drugs to you, which may increase the burden on your liver.
It turns out that blood sugar may also occur if the liver is not good. Today, Dr. Clove will talk about this topic.
Why can you get diabetes if your liver is not good?
Besides pancreas, liver is also an important organ that regulates blood sugar.
The liver is the [warehouse] for storing glycogen. After normal people eat, the blood sugar concentration increases. In addition to providing energy, part of the increased blood sugar will be converted into liver glycogen through the liver and stored in the liver. When blood sugar drops again in the future, the liver can convert glycogen into glucose and release it into the blood to ensure that blood sugar will not drop too low.
In addition, the liver will also provide energy to the human body and participate in metabolism by participating in the process of various hormones, auxiliary fats and proteins becoming glucose.
Therefore, when liver diseases are caused by various reasons, normal glucose metabolism may be affected, resulting in impaired glucose tolerance or diabetes.
Is it different from what if the liver is not good enough to get diabetes and general diabetes?
1. Diabetes is already present, but the liver is not good at the same time.
We are familiar with diabetes, and most of them are type 2 diabetes patients. They are usually fatter and young. They often have hyperlipidemia and fatty liver at the same time. They even have high uric acid (or gout) and hypertension. That is, people who are often referred to as “three highs”, “four highs” and “five highs”.
This group of people often have insulin resistance and/or various metabolic disorders, as is the case with Xiao Wang mentioned at the beginning of the article.
Some patients will have obvious [more than three and less than one] diabetic symptoms of [drinking more, eating more, urinating more and losing weight], but it is also possible that, like Xiao Li, there is no what discomfort, only an accidental increase in blood sugar.
2. Diabetes caused by poor liver
Lao Li mentioned at the beginning of the article belongs to this kind of situation. Generally, after middle age, there are often many years of history of hepatitis B or chronic hepatitis, and liver cirrhosis may have occurred. Liver function is very poor. Diabetes on this basis belongs to secondary diabetes.
They often do not have obvious [more than three and less than one] symptoms, but have many poor liver manifestations, including loss of appetite, fatigue, abdominal distension, splenomegaly, jaundice (white and yellow skin and eyes), ascites, etc.
Different from the first type of primary diabetes, patients with diabetes caused by poor liver can have normal or low fasting blood sugar, even fasting hypoglycemia. However, after eating, due to the decline of liver function, the synthesis ability of liver glycogen is insufficient, and the postprandial blood sugar increases significantly. If the liver function of these patients improves, the blood sugar can generally be controlled.
Prevention and Treatment of Liver-related Diabetes Mellitus
1. Primary diabetes and [three high], [four high] and [five high] populations
(1) Blood sugar measurement: Blood sugar needs to be checked regularly, including fasting and 2 hours after meals.
(2) Diet and exercise therapy: A good lifestyle is the basis for prevention and treatment. Pay attention to diet and avoid foods high in sugar and oil, especially the [invisible] sugar and oil in food. Control the total energy per day and increase fresh vegetables and fruits appropriately. Exercise properly for more than half an hour per day. Maintain appropriate weight and waist circumference to avoid obesity.
These can not only prevent the occurrence of diabetes, but also have therapeutic effects on existing impaired glucose tolerance and mild diabetes. But also have great benefits for other high blood lipid, hypertension and high uric acid.
(3) Drug therapy: However, if the blood sugar has obviously increased or the blood sugar is still not controlled after lifestyle intervention, drug therapy is required under the guidance of doctors.
However, there are some special circumstances, including poor liver and kidney function, complicated with severe infection, heart failure, jaundice, severe osteoporosis and fracture history, doctors need to choose special drugs. When necessary, doctors will consider whether insulin is needed for treatment.
2. Hepatogenic diabetes mellitus
Since this kind of diabetes is caused by poor liver function, maintaining normal liver function as far as possible and reviewing liver function regularly can prevent the occurrence of hepatogenic diabetes.
(1) Monitoring: liver function, fasting blood glucose and postprandial blood glucose.
(2) Diet and exercise therapy: For patients with relatively stable liver function, The principle of dietary therapy is still to control total energy intake. But it doesn’t have to be as strict as ordinary diabetics. The calorie intake should be relaxed appropriately, and foods with high protein, low salt, low fat, high vitamin and easy digestion should be given. The total amount of carbohydrates (this is what we often call [sugar]) should also be relaxed. The key is to control the types and eating habits, but it is best not to eat simple sugars and sweet cakes.
Patients with mild to moderate liver diseases, especially fatter patients, should take moderate exercise, mainly light physical aerobic exercise, once a day, each exercise for about 30 minutes. However, severe liver diseases may require bed rest.
(3) Drug therapy: Can’t simply reduce blood sugar, but should protect the liver, hypoglycemic two-pronged approach. Because liver disease is the real cause of hepatogenic diabetes, simple hypoglycemic palliative. Some patients with mild diabetes or impaired glucose tolerance, after liver function recovery, through diet and exercise adjustment, blood sugar can also return to normal.
However, for patients whose blood sugar is still high,
1) If the liver function is generally normal, it still needs to be controlled by oral drugs, such as acarbose;
2) If the liver function is not good, it is generally not necessary to take oral hypoglycemic drugs. Because the vast majority of oral hypoglycemic drugs have to pass through liver metabolism, it will increase the burden on the liver, aggravate liver diseases and even induce liver failure. At this time, selecting insulin can not only effectively reduce blood sugar, but also benefit hepatocyte repair and liver function recovery.
In addition, due to insufficient liver glycogen reserve during liver cirrhosis, the ability to regulate blood sugar decreases and hypoglycemia is easy to occur, so blood sugar should not be lowered too low to prevent further damage to the liver.
China is a large country with hepatitis B, with a large number of patients with chronic viral hepatitis and liver cirrhosis. As an important chronic non-communicable disease, Now it is getting younger and younger, which has become a new [epidemic]. Liver diseases caused by various reasons may cause blood sugar abnormalities, but in many cases diabetes or glucose tolerance abnormalities occur [quietly]. It is very important to check fasting blood sugar and postprandial blood sugar while regularly reviewing liver function.
When liver disease meets diabetes, it is a headache, but for the vast majority of patients with hepatitis B or mild fatty liver with normal liver function, there is no need to worry too much, continue to maintain good living habits and regular monitoring, which is the basis for our prevention of diabetes.