Cirrhosis plus diabetes

[Cavaschon]

My husband has recent been diagnosed with irreparable cirrhosis, he is also a type 2 diabetic. He’s been told to eat a high calorie diet! He’s waiting to see a dietitian but he’s not got a telephone consultation till the end of August!! Can anyone please recommend things to eat that won’t send his diabetes all over the place?

[Richard-Allen]

This may seem a strange question, but has your husband’s diabetes recently occurred, or was he diabetic before he was diagnosed with having liver cirrhosis? When the liver becomes cirrhotic and covered with scar tissue, it becomes hard for insulin the get through to the liver.

The liver, acts as the bodies sugar factory and makes sure that there is always enough food available for all the muscles to work properly.

We have in our bodies a gene known as the CRTC2 gene (also known as the “switch gene”. There are a number of these genes around our bodies (the brain, liver, and even the placenta) this gene monitors the amount of sugar (glucose) that is in the body at any one time.

If our muscles require a lot more food as in when we run to catch a bus. The CRTC2 gene sends out a message to the liver telling it to dump more glucose into the blood system.

Now, when we’ve sat down and relax. The pancreas sends out insulin to the liver. It is believed the insulin is the signal to the liver to stop dumping sugar.

When the liver becomes scarred as in the case of cirrhosis, this insulin message can’t always get through, so the liver continues to dump more and more sugar.

The liver has become insulin resistant. Avoiding sugary foods is always a good thing and a dietitian maybe able to advise you about this.

Sadly even a liver transplant isn’t always helpful when it comes to diabetes. For some people, the anti-rejection medication that has to be taken daily can alter the way the hepatocytes in the liver handle sugars. But some people have been successful in learning to control their diabetes and even no longer need to take medication.

I hope this helps.

Good Luck

Richard

[Scrags64 in reply to Richard-Allen]

Can I just say I find your assumptive comment that because the gentleman has scirosis very offensive. I have never drunk alcohol in my life, but I have scirosis which wasn't diagnosed until I bled out at home and died twice. Also, my diabetes has never been better controlled since going on insulin 2.5 years ago. I have been diabetic for 20+ years and last hba1c was 42, down from 98 when I was diagnosed. My liver will never get better. I also have fibrosis and hepatitis, but by changing my diet and actually eating about 250g carbs a day I have astounded my consultant. I appreciate this doesn't work for everyone, but people need to have both sides of the story.

[Hidden in reply to Scrags64]

CIRRHOSIS

[Scrags64 in reply to Hidden]

No need to shout and be so rude. I have 21 different diagnosed conditions, including brain fog from ME and my liver, so I'm sorry but I do occasionally spell things incorrectly. Shout at spell checker for not correcting it.

[Hidden in reply to Scrags64]

Wasn't shouting just spelling it correctly for you and anyone else who sees your comment and wishes to know how it is actually spelt. Well l agree with poor grammar on here too but there are many nationalities who write on here so there are reasons why correct English isn't always present so best to turn a blind eye. But l think if you suffer from diseases and conditions, it would be best to know how it's spelt.

[Scrags64 in reply to Hidden]

Guessing you never use any of the Facebook groups then as I have seen much worse spellings than mine, and for much simpler conditions such diabates, diabitis etc etc. I personally feel it is rude to correct people who may not have the intelligence to spell correctly, may be from a different country or culture or who have health issues making it difficult for them.

[Hidden in reply to Scrags64]

🙄

[YummyBear in reply to Hidden]

GRAMMAR!

[YummyBear in reply to Hidden]

GRAMMAR!

[Hidden in reply to YummyBear]

🤣🤣🤣🤣 thankyou... l shall correct immediately

[Scrags64 in reply to Hidden]

And if you want to be really pedantic maybe you should start commenting on the appalling grammar in some posts.

[heslinjones in reply to Scrags64]

Forget ast hba1c was 42, down from 98 when I was diagnosed, The results of this test means nothing if you have cirrhosis.

[Scrags64 in reply to heslinjones]

Not sure where you got that information from, but both my liver consultant and my diabetes consultant said that getting my hba1c under good control would stop there being so much pressure on my liver. I have had both calling me personally in the last week congratulating me on my hard work. 2.5 years ago I was told I would need a liver transplant in a few months, now it is only a maybe. My liver and kidney function tests are all normal, I only have small thrombosis in my portal vein, when it was almost totally blocked and after 17 gastrosopies (and over 70 variciles being banded) in 25 months I only have to have an investigation every six months to check it is all ticking along nicely. I know who I believe, and I intend keeping my hba1c under as strict control as I can.

[heslinjones in reply to Scrags64]

It came from my diabetic consultant. My finger picks showed high. My hb1ac showed 41 which indicates pre diabetic. I take high levels of insulin to counteract diabetes. My nurses could not understand it the consultant told me immediately. Hb1ac is no good if you suffer liver problems. You should double check as it's possible you can go hypo if you rely on hb1ac. Now I have to rely on fingerpricks. As I said from my diabetic specialist

[Scrags64 in reply to heslinjones]

I don't rely on my hba1c. I self fund the libre sensor and so check my sugars every hour as I know from experience that they can rise or drop 3 or 4 points in that time. I am currently running at 95% of the time within range as well.

[heslinjones in reply to Scrags64]

Cirrhosis and advanced liver disease have been associated with an increased risk for hyperglycemia and diabetes mellitus. The diagnostic yield of common tests used to define diabetes in the general population differs from those with liver disease. HbA1c is a reliable test to assess chronic glycemia and recommended both for the diagnosis and monitoring of diabetes mellitus; however, HbA1c is neither accurate nor reliable in patients with cirrhosis. Just found this snippet of information. Only trying to help .okay

[Scrags64 in reply to heslinjones]

I guess it's like everything. Put a group of consultants in a room, ask them a question and their answers will all differ in some way. 🙃

[heslinjones in reply to Scrags64]

Correct but worrying. My concern would be the time duration between hb1ac checks. Fingerpricks are immediate. In fact the consultant said. No point in taking the hb1ac test. We will see. Best of luck.

[Scrags64 in reply to heslinjones]

And to you.

[Richard-Allen in reply to Scrags64]

You are quite right, and l have edited my reply. Sorry for any distress this error may have caused.

[Dd4560 in reply to Richard-Allen]

I still don't understand what was so offensive???

[Hidden]

I would encourage you to speak with your husbands GP. They can perhaps expedite the dietitian appointment. It is important that he has individualised dietetic advice, particularly as he has more than one condition to consider.

There is lots of general information on our website

britishlivertrust.org.uk/

and you can also call our nurse led helpline for support on 0800 652 7330 Mon - Fri 10am-3pm.

Take care,

Trust9

[Scrags64]

Have you looked on the British Diabetes Association website? They have a lot of information. I have also found some good (as well as bad) information on Facebook groups. Hope you and your husband get the help you need soon. X

[chrisw740]

Hi Cavaschon

It can certainly feel like a paradox to be told go high calorie to ensure advanced cirrhosis doesn't contribute to muscle loss and malnutrition - whilst also controlling blood sugar because of type 2 diabetes. It is doable though. The link below may be a useful starting point, think healthy fats and protein with complex carbs. Of course the dietitian should sign off on any changes first.

Also any increase in physical activity will also help with peripheral insulin resistance and contribute to overall health. These things are a challenge so little and often on both fronts. It's allso worth noting that blood glucose levels can appear normal in some patients with cirrhosis (even when they are not) so accurate monitoring is often better served with additional oral glucose tolerance tests.

As always, in terms of a treatment plan, one size does not fit all... so a management strategy specifically suited to your husband, in accordance with his Dr's advice is the best way forward.

Best Chris

medicalnewstoday.com/articl...

[trekmum]

Hi. My own husband had type 2 prior to developing ald cirrhosis. He had been in metformin but in 2019 his liver became decomprnsated. For some reason he was taken off metformin . His liver improved but his health deteriorated. At a routine blood test his blood sugar level was at 35 and he was rushed to hospital. Two hospital stays later and he is now injecting insulin 4 times a day. He eats a normal healthy diet and avoids obvious sugar rich stuff but scary how close he came to stroke or heart failure. Best wishes to you