University Health System Blog

Dr. Evan Klass answers the question: “Can diabetes cause liver damage?”

The relationship between diabetes and the liver has become much more clear over the past five years. Let me first say that type 1 diabetes does not affect the liver. This discussion pertains to type 2 diabetes.

In type 2 diabetes, a primary problem is insulin resistance.

Insulin resistance makes the insulin in your body that’s available less effective in its target organs. These organs include the liver and fat tissue. Insulin resistance can exist before diabetes becomes apparent if the pancreas is able to make enough insulin to overcome the resistance. Eventually, in some people, the pancreas cannot keep up production of insulin and blood glucose begins to rise.

However, insulin resistance itself leads to other hormonal changes which can impact on the liver. Specifically certain fat bodies called free fatty acids are released by fat cells and these can be stored in the liver. This can result in inflammation in the liver which can cause progressive damage. In rare cases, cirrhosis of the liver can result.

The important thing is that this process can be treated with diet modification and medication, but, as with many medical conditions, the sooner treatment is initiated the better.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers a question from Kerry in Reno, Nevada: “Can type 2 diabetes have an effect on a person’s mood, causing anger, irritability and/or depression?”

Type 2 diabetes is frequently associated with mood disturbances, especially depression.

The manner in which it causes these changes is not certain. Is it related to the effect of changes in glucose in the brain or is it related to the stress of having a difficult chronic illness?

Depression is under-diagnosed in patients with diabetes and there is very good evidence that treating depression improves diabetes control.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “What causes reactive low blood sugar?”

Reactive low blood sugar or hypoglycemia is an over-diagnosed condition.

Most people who have symptoms of shakiness and fatigue after meals do not have low sugar when they are tested.

Most of the symptoms are due to insulin released in response to a large load of carbohydrates, especially simple carbohydrates.

These symptoms can be disturbing but are rarely dangerous.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “What is the relationship between obesity and diabetes?”

Obesity has become the nutritional disease of our age.

The causes of obesity are multiple and complex. Certainly our sedentary lifestyle contributes, but it is easy access to inexpensive, calorie dense foods which is primarily responsible.

In the setting of genetic predisposition to type 2 diabetes (formerly adult onset diabetes, for example, a family history of diabetes), increasing body weight increases the risk for developing diabetes.

We can’t change our parents so our genetic risk is permanent. If a woman had diabetes in pregnancy (gestational diabetes) her chance of developing diabetes in the future is significantly increased.

Likewise, women who have polycystic ovarian syndrome are at increased risk, as are patients with hypertension. Your doctor should be aware of these conditions and perform regular screening for diabetes in high-risk individuals.

We should all aim to increase our level of physical activity.

When patients ask how often they should exercise, I say “What’s the matter with every day?”

Exercise does not mean buying a gym membership. It means walking more, using the stairs, mowing the lawn on foot. Anything that gets you moving counts.

When we don’t watch our weight, it climbs.

We need to honestly evaluate where our calories come from and recognize that we all underestimate what we eat. Then we need to start reducing.

Many people benefit by meeting with a registered dietician. The best bet is sensibly reducing your calories and remembering that real weight loss is a slow process.

You can’t lose heart! The sooner you start the sooner you get to your goal.

Finally, it is very important to work with your physician to insure that, if you have diabetes, you are employing all of the appropriate current therapies and that all other cardiovascular risk factors, such as high blood pressure, high cholesterol and smoking, are aggressively managed.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “Is there any connection between hypothyroidism and female infertility?”

Definitely. Hypothyroidism, when it is not treated or not treated adequately, reduces ovulation, and obviously, no ovulation, no pregnancy. In addition, when hypothyroidism is not treated adequately, a woman’s libido or interest in sexual activity may be reduced (no sex, no pregnancy).

Most patients with hypothyroidism have Hashimoto’s thyroiditis [PDF], an autoimmune disease which causes the thyroid to fail. Some people who have normal thyroid function may be found to have Hashimoto’s thyroiditis by doing a specific blood test for thyroid peroxidase antibodies. The presence of these antibodies in the blood, even with normal thyroid hormone levels, has been associated with reduced fertility and with increased risk of miscarriage.

Finally, for women who have hypothyroidism who become pregnant, it’s essential that their thyroid hormone dosage be adjusted early in the first trimester–the dose will almost certainly need to be increased in pregnancy.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “I’ve heard that you shouldn’t eat sweet fruits such as mangoes if you have diabetes. Is this true?”

The sweeter the fruit the more concentrated the sugar content. So the sweeter the fruit, the smaller the portion size needs to be. So when people say that fruit is healthy, it is partly true.

Fruit does contain vitamins and is free of fat, but it has lots of natural sugars. Remember that all sugar is natural–it comes from a plant source.

That’s the problem with fruit juice. Juice gives all of the sugar of many fruit servings–the sugar of about four oranges is in one glass of juice!

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “Can thyroid disease affect your mood?”

Thyroid disease can definitely affect your mood. We often think that thyroid disorders affect only metabolism- weight gain if the thyroid is underactive and weight loss if overactive- but thyroid hormone is definitely active in the brain.

An overactive thyroid or hyperthyroidism may make one edgy or agitated, short-tempered, cause difficulty in sleep, cause problems in “focusing”, or even cause depression. Underactivity of the thyroid or hypothyroidism is more commonly associated with a “foggy” feeling, depression, and also with being “snappy” or short-tempered. Severe hypothyroidism can make one very fatigued.

It is important to remember that once the thyroid function has been returned to the normal range the effect of the disease on mood ends. Any mood issues that persist after the thyroid has been stabilized are not thyroid related and need to be evaluated separately.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “Can I use artificial sweetners if I have diabetes?”

Opinions about artificial sweeteners as it relates to diabetes are about as numerous as the stars. There’s no valid scientific evidence to conclude, however, that there’s a health danger to diabetics from using artificial sweeteners. The U.S. Food and Drug Administration allows their use. You might argue that one has more or less of an aftertaste than another but that’s a personal decision.

Sugar alcohols, such as sorbitol and maltitol, may cause intestinal cramps if you eat too much.

The argument that I find most interesting is whether it’s good or bad for people with diabetes to use artificial sweeteners because it allows them to get used to eating sweet things, which may make it harder for them to stick to their diet plan. I take the opposite position—I think it’s a good thing for people with diabetes to enjoy sweets without having to worry about the effects on their blood glucose.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.