Diabetic Fatty Liver Problems

by Dawn




Question from Dawn: I am 43, have type 2 diabetes, and have lost about two stone through diet and exercise. My blood sugar and cholesterol improved, but a liver blood test was flagged at 40. I do not drink alcohol, and my GP mentioned fatty liver. What does this mean, and what should I do?





Quick Answer


A liver result of “40” cannot be interpreted without knowing which test it was—such as ALT, AST, alkaline phosphatase, GGT, or bilirubin—and the laboratory’s reference range. If it was ALT or AST, 40 may represent a mild elevation, but comparing it with another person’s result of 100 does not show whether your liver is healthy.


Type 2 diabetes and excess weight increase the likelihood of metabolic dysfunction-associated steatotic liver disease, now called MASLD. The next step is to confirm the full liver panel, review medicines and herbal products, exclude other causes, and assess whether any liver scarring is present.




Answer by Dr. Albana Greca, MD, MMedSc



Dear Dawn,



First, losing two stone and improving your glucose and cholesterol are meaningful achievements. Gradual weight loss, regular activity, and better metabolic control can reduce liver fat and may also improve liver inflammation and scarring risk.



Fatty liver in someone with type 2 diabetes is now usually described as metabolic dysfunction-associated steatotic liver disease. It is related to insulin resistance and metabolic risk rather than alcohol alone. Our overview of diabetes and liver disease explains this connection in more detail.



What Does a Liver Reading of 40 Mean?



Ask for a printed or electronic copy of the full results. A liver panel may include:




  • ALT and AST, which may rise when liver cells are irritated

  • Alkaline phosphatase and GGT, which may suggest bile-duct or other liver problems

  • Bilirubin, albumin, and clotting tests, which give different information about liver function

  • Platelet count, which is useful when estimating fibrosis risk



A single mildly abnormal result does not diagnose fatty liver, inflammation, or cirrhosis. Liver enzymes can also be normal in people who have important fibrosis. The result should be interpreted with the test name, sex-specific reference range, previous results, symptoms, medicines, and imaging.



What Should Be Checked Next?



Your GP may repeat the liver panel and review other possible causes, including viral hepatitis, thyroid problems, autoimmune liver disease, medication effects, and alcohol exposure. Bring the exact names, doses, and labels of every prescription medicine, over-the-counter product, and herbal preparation.



This is especially important because some herbal and “detox” products can injure the liver or interact with diabetes medicine. Do not stop prescribed treatment, but pause any nonessential supplement only after discussing it with the clinician who knows your case.



If MASLD is suspected, your doctor may calculate a FIB-4 score using age, AST, ALT, and platelet count. FIB-4 helps estimate the chance of advanced liver fibrosis. A low score may allow monitoring in primary care; a higher or uncertain score may lead to transient elastography, an ELF blood test, or referral to a liver specialist.



An ordinary ultrasound can show liver fat, but it cannot reliably determine whether inflammation or significant fibrosis is present. Elastography is more useful for measuring liver stiffness.



What You Can Do Now




  1. Continue gradual weight loss. Losing about 3%–5% of body weight can reduce liver fat; approximately 7%–10% may be needed for greater improvement in inflammation or fibrosis.

  2. Avoid crash diets. Rapid weight loss and poor nutrition can worsen liver problems.

  3. Choose a Mediterranean-style eating pattern. Emphasize vegetables, legumes, whole grains, nuts, fish or suitable vegetarian protein, olive oil, and minimally processed foods. Our Mediterranean diet guide for diabetes provides practical examples.

  4. Limit sugar-sweetened drinks and highly refined carbohydrates.

  5. Stay active. Physical activity benefits liver health even when weight loss is modest.

  6. Manage glucose, blood pressure, and cholesterol. Cardiovascular disease is a major risk for people with MASLD.



Your diabetes treatment should also be reviewed. Some glucose-lowering medicines may support weight loss or improve liver-related metabolic risk in selected people, but the choice depends on your overall health. See our guide to diabetes medicines, benefits, and side effects.



Can Fatty Liver Be Reversed?



Liver fat can often decrease substantially with sustained weight loss, activity, and improved metabolic health. Early inflammation may also improve. Established fibrosis can sometimes regress, but this is not guaranteed, and advanced cirrhosis requires specialist monitoring.



The goal is therefore not only to normalize an enzyme result. It is to determine whether fibrosis exists and reduce long-term liver, heart, kidney, and diabetes risks.




Important Safety Note


Seek prompt medical attention for yellow skin or eyes, dark urine, pale stools, persistent vomiting, increasing abdominal swelling, severe right-upper abdominal pain, confusion, unusual bleeding, black stools, or marked weakness. These are not typical signs of simple mild fatty liver.





Doctor’s Note


A mildly elevated liver enzyme should not cause panic, but it should not be dismissed by comparing it with someone else’s number. In type 2 diabetes, the important question is whether there is liver fibrosis. I would review the complete laboratory report, calculate fibrosis risk, examine all herbal products, and arrange further testing when indicated.





Educational only: This answer does not replace a liver evaluation, medication review, or individualized diabetes treatment plan.




Related Questions




Related Resources




References



  1. ADA Consensus Report: MASLD and Type 2 Diabetes.

  2. EASL–EASD–EASO MASLD Clinical Practice Guidelines.

  3. NIDDK. Diagnosis of Fatty Liver Disease.

  4. NIDDK. Treatment for Fatty Liver Disease.



Last reviewed: July 2026.



Comments for Diabetic Fatty Liver Problems

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Oct 05, 2012
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starstarstarstarstar 		Fatty Liver and Type 2 Diabetes
by: Bonny Damocles

I was diagnosed as a type 2 diabetic in July 1991 based on a fasting blood sugar reading of 468 mg/dl. I was supposed to be on several anti-diabetes pills but I refused to take them when I heard from a newly-diagnosed diabetic friend that the pharma anti-diabetes drugs he was on were causing him hypo problems.

With the approval of our family physician, I decided to use daily exercise as my only anti-diabetes med.

About 15 years ago, after an annual physical, it was found out that I had fatty liver. Our family doctor could not tell me its cause because I never drank alcohol. He suggested that I continue doing everything I had been doing to control my diabetes, like exercising every day and eating only heart-healthy, natural, fresh (raw or cooked), and unprocessed foods (mostly carbohydrates for me), and wait for my next year's physical results.

Luckily, after my physical the following year, my fatty liver problem was gone.

Since I have been able to control my diabetes successfully going 22 years now with the use of daily exercise as my only anti-diabetes medication, I would like to think that my success in managing my t2d has a lot to do with the elimination of my fatty liver problem.

Enjoy life always!!!

Bonny Damocles
Male, 77 years old, 141 lbs, 5'7"



Choline deficiency leads to a fatty liver

by Anonymous

This is a common condition found in people who are hospitalized and fed intravenous nutrition that lacks choline.

If the supply of choline isn't high enough, those
particles of fat and cholesterol cannot be synthesized and fat will accumulate in the liver.

Thankfully, this condition can be reversed when a person gets enough choline on a daily basis.

So, where do we find choline? Well, the first place is within our own bodies. But this amount is insufficient, so we need to get it through our diet.

Foods rich in choline include milk, peanuts, eggs, and liver. It is estimated that the average intake by American adults is between 730 and 1,040 milligrams per day.

The Food and Nutrition Board of the National Institute of Medicine has established the following adequate intake levels:

-- 550 milligrams/day (mg/day): men, breastfeeding women

-- 425 mg/day: women

-- 375 mg/day: children aged nine to 13

-- 250 mg/day: children aged four to eight

-- 200 mg/day: children aged one to three

-- 150 mg/day: infants

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