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Diagnosed With Fatty Liver. Will It Get Worse? Is It Possible To Be Insulin Resistant With Normal Range?

Posted on Tue, 21 Aug 2012

Question: Hello. My wife (53) was found to have some "fatty liver" and needs to lose around 50 pounds. However her glucose A1C and triglycerides are all in normal range. How likely is it that this condition would either remain stable or worsen whether or not she loses weight? And is this indicative of insulin resistance although she has normal numbers? I have read that the HOMA-IR or clamp test discovers what the other tests do not. But these tests are not tested on the average person, so how is it possible to be insulin resistant with normal range numbers that do not reflect the HOMA-IR or clamp test results that are never even tested?

In my case (age 56) my glucose number has gone down because of my change of diet to lose weight, and my A1C is stable at 6.0 which I know is higher than the usual standard, which causes me worry. Thank you for your input.

Answered by Dr. L K Shankdhar (12 hours later)

Dear Friend

Thanks for utilizing medical services of XXXXXXX

HOMA-IR study is resorted only for research purposes and routinely not practiced in clinical practice.

Clinically waist circumference correlates well with HOMA-IR. In females of US origin 90 cm is the cut off point. Higher waist circumference relates to insulin resistance.

For fatty liver, Pioglitazone might be added under the guidance of your local physician and consumption of alcohol should be curtailed drastically. This should help in controlling this situation. Of course, weight reduction and diet manipulation with low fat content specially saturated ones be on priority.

Hope I have answered all your queries. Let me know if I have missed any of your concerns.

Wishing good health

Regards
Prof. LK Shankhdhar

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. L K Shankdhar (3 hours later)

Thank you. My wife doesn't consume alcohol, and is it possible that fatty liver could worsen or have XXXXXXX effects? At what point is pioglatizone recommended, and does fatty liver usually appear suddenly in middle age? It is unusual that she should have it yet my blood tests do not show fatty liver and I weigh more than her.
What do you think about the risks of bladder or other side effects of pioglatizone which is considered experimental for treating fatty liver?

Answered by Dr. L K Shankdhar (5 hours later)

Dear Friend,

Yes, Fatty liver is potential complication of Diabetes and may worsen if Diabetes, deteriorates or diet contains too much of saturated fats. There are no special instructions for use of Pioglitazone, except for its contra indications which ought to be seen by your family physician.

Regarding risk of bladder cancer; it is observed after 1 year of therapy or total dose of 28grams. Usually Pioglitazone is given 15-30 mg/day and it takes more than 5 years to reach that amount if 15 mg/day is the dose and 2.5 year if 30 mg/day were the dose. Still family physicians must assess your wife's status during the Pioglitazone therapy. Working with your physician during the therapy will benefit her.

I am not commenting on your case as I need many more details, if I were to answer your query.

Hope this suffices. Let me know if you need further information

Wishing good health to both of you

Prof. LK Shankhdhar

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. L K Shankdhar (40 minutes later)

Thank you Dr. Shankdhar. This is very informative. In my case my glucose is 106 (down from 117), my cholesterol is 196, triglycerides 110 and A1C of 6.0 or 6.1%. I have to lose at least 60 pounds and am trying. I have not been checked for fatty liver for several years but my numbers were all higher then, and the fatty liver didi not remain when tested the second time. I suppose it is possible to have numbers within normal ranges (as my wife and me) and yet have a relatively higher A1C or fatty liver.

Answered by Dr. L K Shankdhar (3 hours later)

Dear Friend,

HbA1c might be higher and may not correspond to your usual numbers because of Post meal rise in glucose which might not correspond to conventional 2 hour post meal glucose testing.

Similarly Fatty liver might be unrelated to Diabetes and (Ultrasound) for detecting Fatty liver.

I feel there is no more query in your mail.

Take care.
Prof. LK Shankhdhar

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E