When living with diabetes, it’s important to be aware of other health conditions that could affect you. One of these is fatty liver disease. Many people with diabetes also develop liver issues, which can make managing their health more complicated. Fatty liver disease can be caused by long-term alcohol use, but this article discusses the more common kind: metabolic-associated steatotic liver disease (MASLD), previously known as “nonalcoholic fatty liver disease (NAFLD).”

Read on to learn seven important facts about managing diabetes and fatty liver disease together.

1. Diabetes and Fatty Liver Disease Often Occur Together

Diabetes and fatty liver disease often occur together, largely due to shared risk factors like obesity and insulin resistance. Insulin resistance occurs when the body’s cells don’t respond to insulin, making it harder to regulate blood glucose (blood sugar) levels.

One prevalent type of fatty liver disease is MASLD, which affects more than 30 percent of people worldwide, with and without diabetes. The condition involves excess fat buildup in the liver and is unrelated to alcohol consumption. There is also metabolic dysfunction-associated fatty liver disease (MAFLD), which is similar, but its diagnosis includes other diseases such as type 2 diabetes or obesity rather than risk factors.

Insulin resistance, a key feature of type 2 diabetes, is associated with MASLD. When the body’s cells do not respond well to insulin, this leads to higher blood sugar levels and more fat stored in the liver.

Over time, MASLD can progress to metabolic dysfunction-associated steatohepatitis (MASH), previously called “nonalcoholic steatohepatitis (NASH).” MASH is a more severe form with liver inflammation and damage. MASH can lead to fibrosis (scarring of the liver), cirrhosis (a more advanced form of fibrosis), and even liver cancer if left untreated.

The American Diabetes Association reports that up to 70 percent of people with type 2 diabetes may have some form of liver disease. This finding highlights the importance of liver health in managing diabetes. Regular screening and early management are important to prevent the development of MASLD, MASH, and their associated complications.

2. Managing Blood Sugar Is Important for Both Diseases

Practicing good blood sugar management is crucial for managing both diabetes and managing or preventing fatty liver disease. High blood sugar levels can worsen liver health and increase the risk of complications. Keeping your blood sugar within the target range can help reduce fat buildup in the liver. Regular blood sugar monitoring and following your health care professional’s advice on medication and lifestyle changes are important steps in managing both conditions.

3. Healthy Eating and Exercise Can Help Manage Both Diseases

A balanced diet is important for managing diabetes and fatty liver disease. Eat foods low in saturated fats, refined sugars, and processed carbohydrates. Include plenty of fruits, vegetables, whole grains, and lean meats or proteins in your meals. Gradual, healthy weight loss can improve liver health and help control diabetes. Working with a registered dietitian or nutritionist can help you create a healthy diet that fits your needs.

Regular physical activity is also beneficial for managing both diabetes and fatty liver disease. Aim for at least 30 minutes of moderate exercise most days of the week. Walking, swimming, and cycling can help reduce liver fat, improve insulin sensitivity, and promote overall well-being. The American Heart Association also recommends weight training twice weekly. Find your motivation for why you exercise and a routine you enjoy to make it easier to stick with it in the long term.

4. Some Medications Can Help Treat Both Diseases

There are many treatment options available for managing diabetes and fatty liver disease at the same time. Here are a few options that can help control both conditions.

Medications for Improving Insulin Sensitivity

Insulin resistance is a key factor in both type 2 diabetes and fatty liver disease. Medications that enhance insulin sensitivity, such as metformin, improve how the body responds to insulin. These medications help to control blood sugar levels and reduce liver fat along with further liver damage.

Medications for Reducing Liver Fat

Some medications aim to reduce the amount of fat stored in the liver, which is vital for preventing the progression of fatty liver disease. By decreasing liver fat, these medications help the liver work better and lower the risk of serious complications like cirrhosis and liver cancer.

5. Comorbid Conditions Can Complicate Your Health

“Comorbid” means having one or more additional health conditions that occur at the same time as another main condition. For people with diabetes and fatty liver disease, monitoring for comorbid conditions is essential because they can complicate overall health. Some comorbid conditions may include cardiovascular (heart) disease, high blood pressure, and high cholesterol. Regular check-ups and monitoring can help prevent, detect, and manage these comorbidities early.

Your health care provider may recommend blood tests, liver function tests, and imaging studies to monitor your health status. It’s important to see your health care professional regularly and complete all labs and imaging as soon as possible.

Because lab work and imaging can be expensive, talk to your primary care doctor or a social worker if you’re struggling with the costs. There may be programs to help reduce your expenses. Managing these conditions often involves lifestyle changes, medications, and regular monitoring with your health care team.

6. A Healthy Lifestyle and Balanced Weight Can Improve Symptoms of Diabetes and Fatty Liver Disease

Maintaining a healthy weight and lifestyle is crucial for both diabetes and fatty liver disease. Extra weight, especially around the abdomen (belly), is associated with insulin resistance and increased liver fat. If you’re at a higher weight, even a modest weight loss of 7 percent to 10 percent of your body weight can improve liver health and blood sugar control.

Lifestyle improvements, such as adopting a balanced diet, engaging in regular physical activity, getting sufficient sleep, managing stress, and fostering social connections, can enhance overall health. These changes are beneficial even if they do not result in weight loss, as they contribute to better management of both liver disease and diabetes​​.

It's important not to let the number on the scale discourage you from making healthy lifestyle changes. Consulting with your healthcare team or a weight management specialist can help you develop a personalized plan that is safe and effective for your needs​​.

7. Keeping Up With Medical Appointments Is Important for Managing Diabetes and Fatty Liver Disease

Regular medical appointments are essential for managing diabetes and fatty liver disease. These visits allow your health care team to monitor your condition, adjust treatments, and check for complications. Regular screenings for liver function and other related health issues can help catch problems early. Don't skip your appointments, and make sure to follow your doctor’s advice closely.

Managing diabetes and fatty liver disease together can be challenging. With the right strategies, you can take control of your health. Focusing on healthy eating, regular exercise, and keeping up with your doctor’s appointments can help you control and even improve both conditions.

Talk With Others Who Understand

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What have you done to manage your diabetes and fatty liver disease effectively? Share your comments below, or start a conversation by posting on your Activities page.