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Forum Name: Liver Diseases

Question: Hep C, Cirrhosis, and Diabetes medication question


 lyovar - Sun Nov 15, 2009 11:34 pm

Dear Doctor-
Diagnosed with HCV in 1990, probably contracted in '72 when I was 15 years old. In 1997 I had a liver biopsy, it did not provide a stage #, but says "fibrosis with significant bridging". A prominent Hepatologist in Dallas looked at the slides in 2006 and told me it was "overt cirrhosis". 4 ultra sounds and numerous proddings by doctors since 1975 have always detected an enlarged spleen. I had 12 months interferon/ribavirin combo therapy in 1998, but was not a sustained responder. I had another 12 month combo therapy in 2006, virus undetectable at week 14 thru week 46. I lost my insurance imediately after that treatment so i do not know if I have had a sustained response or not, the cost of the test is prohibitive for me.
During the last Interferon treatment, I developed type II Diabetes which was treated with an oral medication. At the end of the treatment, my blood glucose levels normalized somewhat, so I discontinued the diabetes pills.
This year, I am having trouble with my sugar levels again, A1C is 9.7%. I practice a reasonable diet, and have cut out all sugared foods, also rice pasta etc months ago. I am a carpenter and woodworker so I am quite active.
My Doctor is having me take Metformin 1000 mgs daily the last 2 months. I have always refused to take anything not liver friendly since my HCV diagnosis. I do not drink, take aspirin etc. The Metformin literature implies it is assaulting to the liver.My Doctor does not seem concerned at all, he checked ALT (98) and seems to feel that is (low?)enough. I hate to second guess the guy, but it seems to me that long term use of this drug could speed deterioration of my liver function. I am thinking Insulin injections might be more appropriate (although much more expensive).
Incidentally, my sugar levels are still high after almost 2 months on the Metformin, usually about 160 fasting in the morning. Any insight into my situation will be greatly appreciated. Thanks, Chris in Austin, Texas, 52 yrs, 5'10, 193 lbs
 Dr.M.Aroon kamath - Sun Jul 11, 2010 7:43 am

User avatar Hi,

Studies show that up to 96% of patients with cirrhosis may be glucose intolerant and 30% may have clinical diabetes(DM).

DM, which develops as a complication of cirrhosis, is designated as "hepatogenous diabetes". Some studies indicate that this condition is proportionately higher in patients over the age of 6o, women, people of European descent, and lower in people of African or Asian descent.

Hyperinsulinemia and Insulin resistance in muscular and adipose tissues seem to be the underlying factors of diabetes in liver disease. An impaired beta-cell response in the pancreatic islets and hepatic insulin resistance may also be contributing factors.

Alcoholic cirrhosis, non-alcoholic fatty liver disease, chronic hepatitis C (CHC) and hemochromatosis are seen to be more frequently associated with DM.

Insulin resistance increases the failure of the response to treatment in patients with CHC and enhances progression of fibrosis.

DM in cirrhotic patients may be subclinical. Hepatogenous diabetes appears to be distinct from type 2 DM, since microangiopathy appears to be less common and patients more frequently suffer from complications of cirrhosis. DM increases the mortality of cirrhotic patients (not per-se, but on acccount of the liver failure).

Treatment of the DM is rather complex in this situation due to liver damage on one hand and hepatotoxicity of oral hypoglycemic drugs on the other.

Some reports indicate that when diabetes starts before cirrhosis, the need for insulin is usually higher,than
when diabetes follows cirrhosis (a low-glucose diet
may be enough).


Some studies recommend that Diabetic patients with
chronic hepatitis or compensated liver cirrhosis (Child-
Pugh A) can be treated with oral hypoglycemic
drugs, preferably those with the shortest length of
action. In the remaining patients, the use of regular
insulin at meal times is recommended, avoiding delayed
formulations of insulin(high risk of severe
hypoglycemia).


I trust this information may be useful to you.
Best wishes!

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