The liver is one of the most important organs in our bodies, playing a central role in several vital processes. A key function of the liver is regulating blood glucose levels which is crucial for people with diabetes. A healthy liver helps keep blood glucose within the ‘normal range’ and protects against excessive fluctuations which is vital as high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia) can both be dangerous for the human body.
What is the liver?
The liver is the largest internal organ of the human body, weighing approximately 1.4 kg (3 lb) in the average adult. Located under your diaphragm (more to the right side of your body), it is a wedge-shaped, spongy organ that performs a number of key functions, including regulating blood sugar levels, getting rid of toxins (body detoxification) and bile production. It also acts as a major filter of the blood travelling from the digestive tract to the rest of the body.
The liver’s primary function
The liver helps maintain a stable blood glucose level by releasing glucose into the bloodstream when needed, especially during fasting or between meals. When the body senses a drop in blood glucose, the liver taps into its glycogen stores (a form of glucose storage) and releases glucose to keep your energy levels stable. This process is known as gluconeogenesis and allows the liver to create glucose from non-carbohydrate sources, such as proteins and fats, ensuring the body has a constant energy supply even if you haven’t consumed glucose through food.
Liver as a fat-burner
Beyond glucose regulation, the liver is also essential in weight management, especially in the context of fat metabolism. When glucose is not readily available (for example, during fasting or low carb diets), the liver starts converting stored fat into fatty acids and ketones, which the body can then use as an energy source. This process is referred to as “fat-burning,” and it plays a critical role in reducing fat stores and supporting weight loss. A healthy liver supports efficient fat metabolism by burning triglycerides (a type of fat) for energy. However, when the liver is overwhelmed by excess fuel, such as from a high-calorie diet or chronic stress, it begins to store fat instead of burning it. This can lead to non-alcoholic fatty liver disease (NAFLD), a condition commonly seen in people with diabetes and obesity. NAFLD can further impair the liver’s ability to regulate glucose and burn fat, creating a cycle that makes weight management more difficult.
Stress and the liver’s response
The body’s stress response is deeply tied to liver function. When under stress, the adrenal glands release hormones like cortisol, which travel to the liver and trigger the release of stored glucose into the bloodstream. This release is part of the “fight or flight” response, providing the body with quick energy to deal with stressors. However, prolonged stress can cause the liver to continuously release glucose, contributing to insulin resistance, a key factor in the development of type 2 diabetes.
- Read more on stress and blood glucose levels
Chronic stress can also lead to poor eating habits and excess calorie intake, putting additional strain on the liver. It’s important to manage stress through relaxation techniques and balanced routines to reduce its impact on both liver function and overall health.
The liver’s role during exercise
Exercise also plays a key role in supporting liver function and maintaining blood glucose control. During physical activity, the muscles use stored glycogen as a source of energy. As glycogen is used up, the liver releases glucose into the bloodstream to fuel the body further. The liver can only store a certain amount of glucose and so if exercise is sustained or prolonged, the body will switch to burning fat for energy. The liver converts this fat into ketones, another energy source that supports continued physical activity. This transition to fat metabolism supports weight loss and fat-burning, making regular exercise vital for liver health and diabetes management.
The liver and cholesterol
The liver also plays a critical role in regulating cholesterol levels. It produces cholesterol, which is necessary for building cells and producing certain hormones. However, the liver also removes excess cholesterol from the bloodstream, converting it into bile salts for digestion. Imbalances in cholesterol – specifically high low-density lipoprotein (LDL) or “bad” cholesterol – can lead to fatty build-up in the liver, increasing the risk of NAFLD and other cardiovascular problems.
- Read more on cholesterol and the body
Keeping cholesterol levels in check through diet, exercise, and, when needed, medication is essential for maintaining liver health.
Protecting and supporting your liver
For optimal glucose control and effective weight management, it’s essential to take care of your liver. Here are some practical steps to support liver health:
- Eat nutrient-dense foods: Prioritise whole, unprocessed foods that provide the essential nutrients your liver needs to function properly.
- Stay hydrated: Water helps your liver flush out toxins and aids in its various metabolic processes.
- Engage in regular physical activity: Exercise helps improve liver function by promoting fat burning and reducing fat accumulation in the liver.
- Practice periods of fasting: Giving your liver time to rest, such as through intermittent fasting, can help it burn stored fat for energy and maintain glucose balance.
- Reduce processed foods and sugars: Cutting back on ultraprocessed foods, refined sugars and unhealthy fats reduces the strain on your liver, helping it manage glucose and fat more efficiently.
By adopting these habits, you can enhance the liver’s ability to regulate blood glucose, support fat burning, and improve overall metabolism, which is especially important for individuals managing diabetes.
Liver checks
Liver health checks typically include measurements of liver enzymes (such as ALT and AST), which indicate liver inflammation or damage. An ultrasound can also help detect the build-up of fat in the liver. If you’re diagnosed with NAFLD or another liver condition, your GP will guide you on the best course of action, which may include lifestyle changes and medication to manage the condition.
Non-Alcoholic Fatty Liver Disease (NAFLD)
One of the most significant concerns for people with diabetes is the risk of developing non-alcoholic fatty liver disease (NAFLD). This condition occurs in at least 50 per cent of people with type 2 diabetes and close to half of those with type 1 diabetes, and, unlike other liver problems, is not linked to alcohol consumption. This condition can progress to more serious liver damage, including cirrhosis, liver failure, and liver cancer. The risk of developing this disease is increased by the presence of diabetes, as well also increased by other medical conditions related to diabetes, including:
- Obesity
- High blood pressure (hypertension) and
- High cholesterol
The presence of non-alcoholic fatty liver disease is known to raise the risk of liver inflammation or scarring (cirrhosis), and is also associated with an increased risk of liver cancer and heart disease. If you are diabetic and are diagnosed with non-alcoholic fatty liver disease, your GP may recommend an ultrasound inspection of your liver upon diagnosis, followed by regular blood tests to monitor your liver function.
- Read more on non-alcoholic fatty liver disease
Managing blood sugar levels effectively, losing weight, and maintaining a healthy lifestyle are essential strategies to reduce the risk of NAFLD. Regular check-ups and monitoring liver function through blood tests or imaging are recommended to catch potential liver issues early.
