When you’re living with diabetes, you may also experience other medical conditions. For example, some DiabetesTeam members have discussed being diagnosed with liver issues. “Anyone else here dealing with fatty liver?” one member asked.

One relatively common type of fatty liver disease, metabolic dysfunction-associated steatotic liver disease (MASLD), affects about one-quarter of people worldwide. Most people don’t know they have it because they don’t have any noticeable symptoms. However, between 2 percent and 5 percent of those with MASLD develop other complications as a result. (This condition used to be known as “nonalcoholic fatty liver disease” but was renamed to more accurately describe it as a metabolic problem.)

Diabetes and fatty liver disease occur together more often than you might think. In fact, the American Diabetes Association says that liver disease affects up to 70 percent of people with type 2 diabetes, most often in the form of MASLD.

Although having one condition doesn’t necessarily guarantee you’ll get the other, MASLD is much more common in people with diabetes than in those without diabetes. Type 2 diabetes and MASLD share many risk factors but affect different systems of the body.

Given the strong link between these two conditions, everyone with type 2 diabetes should be aware of their increased risk of fatty liver disease and understand how to prevent and treat it.

What Is Fatty Liver Disease?

Fatty liver disease is a serious health problem in which a buildup of excess fat affects the liver. If left untreated, fatty liver disease can raise the risk of heart disease, permanent liver damage (like cirrhosis and fibrosis), and liver cancer.

Some forms of fatty liver disease are caused by drinking too much alcohol, but in MASLD, the fat accumulation is usually a result of obesity (having a high body mass index, or BMI), diabetes, high blood pressure, or high lipid levels. When people end up with a fatty liver despite not having other risk factors, genetics may be to blame.

It’s normal to have some fat in the liver. However, if fat makes up more than 10 percent of the liver’s total weight, that situation becomes a concern.

MASLD can be particularly dangerous during pregnancy. Pregnant people with MASLD have a three to four times higher rate of issues like high blood pressure, including preeclampsia (a type that develops during and just after pregnancy). MASLD also puts the fetus at risk, so additional monitoring and precautions may be required.

A possible complication of MASLD is steatohepatitis, which is ongoing liver inflammation. The technical term for this condition is “metabolic dysfunction-associated steatohepatitis” (MASH). Over time, MASH can cause lasting liver damage and scarring that impair liver function. About 20 percent of people with MASLD develop inflammation and, eventually, MASH. (MASH used to be known as “nonalcoholic steatohepatitis,” or NASH.)

Type 2 Diabetes and MASLD

Type 2 diabetes and MASLD share the same underlying driver: insulin resistance (when the body’s cells don’t respond well to insulin, a hormone that helps control blood sugar levels). Despite this clear connection, research suggests that many people with diabetes aren’t screened for MASLD as often as they should be. This common oversight leaves some people undiagnosed with the early stages of MASLD, allowing the disease to progress to later stages and become harder to treat.

About 83 percent of deaths from cardiovascular disease and up to 66 percent of deaths from any cause are thought to be related to poor management of MASLD, according to the American Diabetes Association.

If you have type 2 diabetes, it’s a good idea to bring up the topic of liver health with your medical provider. They can help assess your risk and monitor for changes that may suggest a problem with your liver. Fortunately, many of the positive changes you can make to manage diabetes can also help prevent or slow the progression of MASLD.

How To Manage Both Conditions

A combination of medical and lifestyle interventions may allow you to manage liver issues and diabetes at the same time.

Eat a Healthy Diet

For some people, gradual and healthy weight loss can help reverse MASLD and stop it from getting worse. Experts recommend following a healthy diet that’s low in saturated fat and added sugars to manage both conditions. If you’re not sure what diet and lifestyle changes you should make, seek support from a registered dietitian. You may be able to participate in cooking classes or group nutrition workshops to learn more about how to eat right with insulin resistance.

Some members of DiabetesTeam said it took some time to meet the right dietitian for them. “Last month, the hospital rang me to say they have a new dietitian who might suit me better. I went, and this lovely young lady gave me some amazing tips plus loads of support, which has me six pounds lighter,” one member shared.

If you didn’t find nutritional counseling helpful in the past, it may be worth trying again with a new provider.

Stick to Your Treatment Plan

Taking your diabetes medications can also help protect against fatty liver disease and steatosis. For example, glucagon-like peptide 1 (GLP-1) receptor agonists and pioglitazone (Actos) are recommended for treating both conditions simultaneously.

Although it’s not the right treatment option for everyone, bariatric surgery can drastically improve type 2 diabetes and the risk of liver disease. In addition, the U.S. Food and Drug Administration (FDA) approved a medication called resmetirom (Rezdiffra) to treat MASLD in March 2024. Your doctor can help you decide if it’s a good fit for you based on your medical history and other medications for diabetes care.

Exercise Regularly

Physical activity is also an essential part of the puzzle for better health. Most people should aim to exercise for 30 minutes a day. Finding a type of exercise or an active hobby that you enjoy can help you stick with your program and make the most of your time working out.

Members of DiabetesTeam have shared tips to encourage others to be more active. “Music always gets me motivated to exercise,” one member said. “If it’s too hot outside, I put on Pandora and have a station I tailored to play great music to exercise to. Some exercises I do are running up and down stairs, jumping jacks, lunges, pushups, various arm exercises using 5-pound weights, and leg exercises. I also have yoga DVDs I can do at home.”

Meet with your doctor to discuss the best ways to screen for liver issues and manage them if they arise.

Talk With Others Who Understand

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, more than 156,000 members come together to ask questions, give advice, and share their stories with others who understand life with type 2 diabetes mellitus.

Were you aware of the higher risk of liver disease with diabetes? Do you have any tips for maintaining a healthy body weight, improving insulin sensitivity, or keeping blood sugar under control? Share your comments below, or start a conversation by posting on your Activities page.