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Diagnosed with diabetes, fatty liver and high cholesterol. Liver enzymes and bilirubin elevated. What will help?

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Practicing since : 2000
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Dear Doctor,
I am 36yrs of age and was diagnosed with Type 2 Diabetes, Fatty Liver and High Cholestrol in 2006. My Liver Enzymes and Indirect Bilirubin(>1)were elevated. The abdomen scan shows mild fatty liver. I was on following medication Udiliv 300, Sorbiline Syrup, Livopill, Evion and Lopid for approx 3months along with weight reductions life style and controlled diet. This significantly brought down the Liver enzymes and cholestrol level but indirect bilirubin continued to remain high. After medicine was discontinued the liver enzymes again went high. The medicine was changed to Essentiate Cap which controlled the Liver enzymes. My current weight is ~71Kg with height 5feet & 5 inches. In 2009 repeat of abdomen scan reveals no fatty liver and liver enzymes within the prescribed limit. But the indirect Bilirubin contrinued to remain high (>1). In 2011 I was put on Udimarin Forte and Liv Fit to bring down the Indirect Bilirubin but it contrinued to remain high as statede. The diabetes is controlled and HbA1C is close to 6 with avaerage sugar is ~120. I am very much concerned with the Liver Functions. Kindly suggest.
I want to mention that In 2009 time frame I was on Atorva 10mg for almost 1 year to check cholestrol levels.
For Diabetis, I take Glyciphage 500 3 times a day with Neurobian. Sorry for frequent writing as this is my first experience.
Posted Wed, 2 May 2012 in Digestion and Bowels
Answered by Dr. Poorna Chandra K.S 8 hours later

Thanks for the query.

I have gone through your query and reviewed the reports attached. After going through them, my opinion is as follows.

1. Presence of fatty liver (on ultrasound reports) with inflammation (raised liver enzymes) is seen in a condition called Non Alcoholic Steatohepetitis (NASH). You are rightly managed for XXXXXXX Continue with the medications and lifestyle measures strictly as advised.

2. Mild rise in indirect bilirubin is either because of low grade hemolysis (destruction of RBC) or a harmless genetic condition called Gilbert's syndrome. People with Gilbert's syndrome can have fluctuant levels of bilirubin upto 5mg/dl, most of it being the indirect fraction. This is a harmless condition and does not affect the liver or your health. On the contrary XXXXXXX is associated with rise in direct bilirubin.

Hence if I were to be your treating doctor, I would get hemoglobin with reticulocyte count and a serum G6PD to rule out hemolysis. Appropriate treatment while continuing treatment of XXXXXXX is needed if the tests are consistent with features of hemolysis. You may discuss about these options with your gastroenterologist.

Hope this answer is both helpful and informative. Should you have any additional concerns, I will be available to address them. Do accept the answer if you do not have any further queries.

Above answer was peer-reviewed by
Follow-up: Diagnosed with diabetes, fatty liver and high cholesterol. Liver enzymes and bilirubin elevated. What will help? 6 hours later
Thanks for your prompt reply! I will get the tests done as recommended. Can you suggest medications for XXXXXXX based on the report attached? Currently, I am not taking any medicines. However, I am following the diet and lifestyle as advised. Also, would like to know if NASH/Elevated Liver Enzymes causes Lethargy, Lack of Concentration etc.
I am tetotaller and want to add that I have never been anaemic. The Blood Routine Culture tests are Normal.
Answered by Dr. Poorna Chandra K.S 1 hour later
Thanks for the follow up
Non-alcoholic steatohepatitis which is associated with significant inflammation ( which manifests in the form of raised enzymes) can cause lethargy and tiredness. Gilbert's syndrome may be associated with some tiredness.
As far as medications for XXXXXXX are concerned, since your liver enzymes are normal at present, you do not need any medication and need to make the following lifestyle changes:
a.     Exercise regularly
b.     Modify your diet appropriately as suggested
c.     Take lots of fresh fruits and vegetables in the diet.

I hope I have answered your query. Please accept my answer if you have no further queries.

Above answer was peer-reviewed by
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