What's the Link Between Hepatitis C and Diabetes?

When you have hepatitis C, worries about diabetes might not be the first things that jump to mind. But the two conditions are tied much more closely than you may think.

For starters, hepatitis C makes you more likely to get diabetes. If you do get it, it can speed up the impact of hepatitis C and raise your odds of having serious liver damage. 

If you've got hepatitis C, how do you know you're on the road to getting diabetes, too? The warning sign is a problem called insulin resistance.

How Does Insulin Resistance Work?

When you eat, your body breaks your food down into smaller parts. One of them is glucose, a type of sugar that's like fuel for cells. During a meal, glucose goes into your blood and travels around your body.

But it needs help getting into your cells, which is where insulin comes in. It's like a doorman who has just the right key.

What's your liver have to with all of this? It acts as a glucose bank. When your blood sugar's high, like during a meal, insulin tells your liver, "Save that glucose for later. You're going to need it." And your liver stores it away.

Later on, between meals or when you're sleeping, your liver releases some glucose back into your blood.

That's how you want it all to work. When you have insulin resistance though, your cells keep the door shut even though the insulin is right there. So then you make even more insulin to try to keep your blood sugar in check, but over time, your body may not be able to keep up.

If that happens, your blood sugar climbs and you're in danger of diabetes.

And, it turns out, hepatitis C makes you much more likely to have insulin resistance.

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How Does Hepatitis C Cause Insulin Resistance?

Because your liver helps manage blood sugar, any type of liver disease can lead to insulin resistance. With hepatitis C though, the two are tied together in a stronger way than usual. As many as half of folks with hepatitis C also have insulin resistance.

Doctors don't know exactly why this link is so strong. It seems that hepatitis C can affect both how much insulin you make and how well it works to control your blood sugar. But it's not clear how it does that.

At the very least, if there are already reasons that you're more likely to get insulin resistance, like being very overweight, your hepatitis C can help tip the scales.

How Does Insulin Resistance Affect Hepatitis C?

Both insulin resistance and diabetes are like adding serious fuel to the hepatitis C fire. They make the effects of it worse at every step, from early liver damage to how you'd respond to a liver transplant.

They cause scarring in your liver and make it soak up more fat than usual. As those problems build up, your liver can't work as well, which puts you on the fast track for problems like cirrhosis, liver cancer, and liver failure.

They can also change how well hepatitis C drugs work for you early on and over the long haul. You could even lose ground after early success with hepatitis C treatment.

How Would I Know If I Had Insulin Resistance?

The only way to know is to get a blood test. Most of the time, you won't see any signs or symptoms, so there's nothing to tip you off. The key is to know if you're more at risk for it. And if you have hepatitis C, you are.

What's the Best Treatment?

Doctors don't yet have a clear answer, but there's been a lot of research into it. It does seem that if hepatitis C drugs can clear the virus out of your body, it has a string of good effects.

First, it may lower insulin resistance and prevent diabetes. If you already have diabetes, hepatitis C can make it worse. It's like each disease eggs on the other. So if you can kick out the hepatitis C, it may slow down some of the more serious issues that diabetes can lead to, like heart or kidney problems.

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The catch is that having insulin resistance may mean hepatitis C drugs don't work as well for you. Newer types of hepatitis C meds, called direct-acting antivirals, may have better success with insulin resistance than older ones.

Your doctor may also ask you to take the same steps as if you only had insulin resistance. Mainly, that means you should try to lose weight through healthy eating and exercise. And your doctor might suggest a drug like metformin, which may help your body make better use of its insulin.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on August 18, 2019

Sources

SOURCES:

American Diabetes Association, Diabetes Forecast: "What's the Link Between Hepatitis C and Type 2?"

Liver International: "Hepatitis C and diabetes: one treatment for two diseases?"

U.S. National Library of Medicine: "Hepatitis C virus and type 2 diabetes," "Hepatitis C Virus, Insulin Resistance, and Steatosis," "Sustained virological response reduces incidence of onset of type 2 diabetes in chronic hepatitis C," "Hepatitis C and insulin action: An intimate relationship."

National Institute of Diabetes and Digestive and Kidney Diseases: "Prediabetes & Insulin Resistance."

University of California, San Francisco: "The Liver and Blood Sugar."

Expert Review of Gastroenterology and Hepatology: "Insulin resistance in chronic hepatitis C: the search for effective drug treatment continues."

Hepatology: "Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients."

American Association for the Study of Liver Diseases and Infectious Diseases Society of America: "When and in Whom to Initiate Hepatitis C Therapy."

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