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Dr Anuj Maheshwari, Lucknow 01 February 2018

diabetes presenting with microangiopathy with hepatic sinusoidal fibrosis and basement membrane collagen deposition without cirrhosis. It occurs in patients with T1DM more often than T2DM. The risk of developing diabetic hepatopathy depends on both the duration and the severity of hyperglycemia. It has been suggested that patients who take excess insulin and treat the subsequent hypoglycemic episodes by administering glucose also promote hepatic glycogen accumulation.
Accumulation of hepatic glycogen is promoted by high cytoplasmic glucose concentration in the presence of insulin. It occurs mostly in type 1 diabetics after receiving supraphysiological doses of insulin. It presents in metabolically decompensated conditions and in diabetic ketoacidosis states.
Diabetic hepatopathy manifests hepatic symptoms and evidence of liver dysfunction but it is different than fatty liver as there is no steatosis and it never progresses to cirrhosis. It is reversible on achieving good glycemic control with optimum insulin therapy without causing hypoglycemia.
Insulin pump is very good option for such patients. Diabetic diet and weight loss helps in reversal.

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