Prateek Tanmay
5 min readUpdated: Jul 29, 2026 07:55 AM IST
When 58-year-old Ramesh (name changed), who had been living with Type 2 diabetes for over a decade, came for his routine diabetes review, he expected the conversation to revolve around his blood sugar levels, medication and HbA1c or the three-month average sugar count. Instead, I suggested a liver function test and asked if he had been vaccinated against hepatitis B. He looked puzzled. “Doctor,” he asked, “I have diabetes. Why are we talking about my liver?”
It’s a question I hear often in my clinic. Most people think of diabetes as a disease that affects the heart, kidneys, eyes and nerves. Very few realise that the liver plays an equally important role in diabetes, and that looking after liver health is an essential part of managing the condition. My patient had silently developed fatty liver.
I have diabetes. Should I also be worried about liver diseases like hepatitis?
The short answer is yes. People with Type 2 diabetes have a higher risk of developing liver disease, particularly fatty liver disease. If they also develop viral hepatitis, they are more likely to experience complications. Yet the liver is often overlooked during routine discussions about diabetes, even though it is central to the body’s metabolism and blood sugar regulation.
How exactly are diabetes and liver disease connected?
The liver stores glucose and releases it whenever the body needs energy. In people with Type 2 diabetes, insulin resistance causes fat to accumulate in the liver over time. Doctors now refer to this condition as metabolic dysfunction-associated steatotic liver disease (MASLD), and it is extremely common among people with diabetes.
The concern is that MASLD is usually silent in its early stages. Left unchecked, it can gradually progress to liver inflammation, scarring, cirrhosis and, in some cases, even liver cancer. This is why liver health deserves far more attention in people living with diabetes.
Does having diabetes increase my risk of hepatitis?
It can. Hepatitis B and hepatitis C are the two viral infections we watch most closely. People with diabetes have a somewhat higher risk of hepatitis B, particularly in settings where infection control during medical procedures or routine glucose monitoring is inadequate. Hepatitis C has a different relationship with diabetes. It actually worsens insulin resistance and can increase the likelihood of developing type 2 diabetes. In many ways, the relationship between diabetes and hepatitis is a two-way street, with each condition influencing the other.
If I already have hepatitis or liver damage, will it make my diabetes harder to manage?
Yes, it often does. A damaged liver struggles to regulate blood sugar effectively, causing glucose levels to fluctuate unpredictably. In advanced liver disease, doctors may also need to adjust the doses of diabetes medications because the liver is responsible for processing many of these drugs. That is why diabetes and liver disease should never be managed in isolation. They need to be addressed together to achieve the best outcomes.
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Are there symptoms I should watch out for?
Unfortunately, this is what makes liver disease particularly challenging. Fatty liver disease and chronic hepatitis rarely cause symptoms in their early stages. Most people feel perfectly well until significant liver damage has already occurred.
Rather than waiting for symptoms to appear, regular check-ups and appropriate screening are the best ways to detect liver problems early, when they are most treatable.
Should I have my liver tested as part of my diabetes care?
In many cases, yes. As part of comprehensive diabetes care, your doctor may recommend liver function tests, an ultrasound examination or other specialised investigations if anything appears abnormal.
If you have received blood transfusions in the past, have been exposed to unsafe injections or have a family history of hepatitis, it is also worth discussing screening specifically for hepatitis B and C with your healthcare provider.
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Should I get vaccinated against hepatitis?
If you have not already received the hepatitis B vaccine, I would strongly recommend discussing it with your doctor. Vaccination is one of the simplest and most effective ways to protect yourself against hepatitis B infection and the long-term liver damage it can cause.
Besides vaccination, what else can I do to protect my liver?
The encouraging news is that the same healthy habits that help control diabetes also protect the liver. Keeping your blood sugar under good control, staying physically active and maintaining a healthy weight all reduce stress on the liver. A balanced diet rich in vegetables, fruits, whole grains, pulses and healthy fats, while limiting sugary foods, refined carbohydrates and saturated fats, benefits both conditions.
Equally important is avoiding alcohol and refraining from taking medications or herbal supplements without medical advice, as some of these can be harmful to the liver.
So, looking after my liver is really part of looking after my diabetes?
Absolutely. A healthy liver supports better glucose control and reduces the risk of serious complications in the future. Sometimes, the most important complications are the ones we do not think about until someone reminds us to look for them.
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(The author is chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai)
