[Diabetes mellitus and the liver]

Liver diseases are frequently associated with disorders of the carbohydrate metabolism--impaired glucose tolerance, hyperinsulinaemia, insulin resistance. Impaired glucose tolerance is due in particular to impaired glucose uptake in the splanchnic area and periphery. Glucose production by the liver is normal, similarly as insulin secretion. Its reduced clearance leads to hyperinsulinaemia with subsequent down regulation of insulin receptors and the development of insulin resistance. In diabetic subjects hepatomegaly is frequent, most frequently associated with steatosis of the liver. It correlates with the degree of obesity rather than the type of hepatic lesion. It is reversible for a long time and develops into cirrhosis only when combined with other factors, in particular alcoholism or infection with hepatotropic viruses. Cirrhosis of the liver is also more frequent in diabetic subjects. Treatment with antidiabetics is discussed, attention is drawn to new types of biguanides, which may have some advantages. Cholelithiasis is in diabetic subjects three times more frequent and leads more frequently to serious, in particular inflamatory, complications with an adverse course. Therefore cholecystectomy should be contemplated. According to contemporary views it seems that diabetic hepoatopathy proper does not exist. The authors draws practical conclusions for the everyday work of physicians.