In people with diabetes, the liver helps maintain blood glucose levels but is also vulnerable to damage. Insulin normally signals liver cells to store or release glucose as needed. However, chronic high blood glucose can damage the liver, leading to excess fat, inflammation or scarring. As a result, the liver becomes less responsive, contributing to insulin resistance.
Over time, this two-way relationship can raise blood glucose levels and cause progressive metabolic dysfunction-associated steatotic liver condition (MASLD).
MASLD, is a condition caused by the accumulation of excess fat in the liver in people with metabolic risk factors. It reflects changes in how the body processes and stores energy and is closely linked to insulin resistance.
MASLD develops gradually and often without symptoms in the early stages. In some people, fat accumulation in the liver can lead to inflammation and liver cell damage, a condition known as metabolic dysfunction-associated steatohepatitis. Over time, this can progress to liver scarring and reduced liver function.
MASLD and type 2 diabetes frequently occur together. With early identification, appropriate care and ongoing support, people living with MASLD and diabetes can reduce their risk of complications and live well.
Who is at risk of MASLD
MASLD can affect people of all ages, though it is most commonly diagnosed in adults. People at higher risk include those who:
- Live with type 2 diabetes
- Have overweight or obesity
- Have high blood pressure
- Have unhealthy ranges of cholesterol or triglyceride levels
- Are physically inactive
- Have a family history of metabolic conditions
People living with type 2 diabetes are at particularly high risk, with MASLD affecting up to 70% of people with the condition. MASLD may also be present in people with normal liver enzyme levels, which can delay diagnosis.
Common symptoms of MASLD
MASLD often has no clear symptoms, especially in the early stages. When symptoms are present, they may include:
- Persistent tiredness or fatigue
- Discomfort in the upper right side of the abdomen
As the condition progresses, symptoms may become more noticeable and may indicate more advanced liver involvement. However, many people remain unaware they have MASLD without appropriate testing.
Causes of MASLD in people with diabetes
Metabolic dysfunction causes MASLD, with insulin resistance reducing the body’s ability to use insulin effectively. This leads to increased blood glucose levels and the storage of excess fat in the liver.
Causes that contribute to MASLD include:
- Excess energy intake and consumption of high processed foods and sugars
- Low levels of physical activity
- Genetic predisposition
- Hormonal and metabolic changes
In people living with type 2 diabetes, insulin resistance is already present, which increases the likelihood of fat accumulation in the liver. This interaction can affect metabolic control and liver health.
MASLD is less common in people with type 1 diabetes, but it is still possible, particularly if other metabolic risk factors are present.
Diagnosing MASLD
Diagnosing MASLD can be challenging because it often develops without symptoms. It is frequently identified during routine health checks or when assessing people living with diabetes.
Diagnosis may involve:
- Blood tests to assess liver enzymes and metabolic markers
- Imaging tests, such as an ultrasound to detect fat in the liver
- Non-invasive procedures to evaluate liver fibrosis or scarring
Early and accurate diagnosis is important for guiding care and reducing the risk of progression.
Treating MASLD
There is no single specific treatment for MASLD. Management focuses on improving overall metabolic health and reducing liver fat. This is typically achieved through a combination of lifestyle and clinical approaches that support long-term health.
Initial management involves adopting a healthy, balanced diet, increasing physical activity and aiming for a healthy body weight. These changes can improve insulin sensitivity, support better blood glucose levels and reduce liver fat. In addition, regular monitoring of blood glucose, blood pressure, and lipid levels can reduce the risk of further complications and support liver health.
Treatment may need to be adjusted over time based on individual needs and the progression of the condition. In people living with type 2 diabetes, some medications used to manage blood glucose may also benefit liver health. Care should always be personalised, with regular review and support from healthcare providers to ensure the most appropriate and effective approach.
Living with MASLD
Living with MASLD and diabetes involves long-term management and support. The aim is to maintain liver health and overall well-being.
Key aspects of care include:
- Monitoring blood glucose levels and liver health
- Eating a healthy, balanced diet
- Maintaining regular physical activity
- Following a personalised treatment plan
- Accessing emotional and psychological support when needed
Care needs may evolve over time. With the right support, people living with MASLD and diabetes can take an active role in their care and maintain a good quality of life.
When to talk to a healthcare professional
It is important to speak with a healthcare provider if you:
- Live with diabetes and have not assessed your liver health
- Have risk factors such as overweight, high blood pressure or abnormal cholesterol
- Experience ongoing fatigue or abdominal discomfort
- Have difficulty managing blood glucose levels
Early consultation can support timely diagnosis and personalised management.
