Liver cirrhosis and diabetes: Risk factors, pathophysiology, clinical implications and management

Figure 2 Liver damage caused by type 2 DM. Insulin resistance promotes release of free fatty acids (FFA) from adipose tissue. The FFAs are accumulated in the liver cells, and de novo liponeogenesis (DNL) contributes also. The reduced secretion of very low density lipoprotein (VLDL) by hepatic cells saturates hepatocytes producing steatosis. Mitochondrial oxidative stress is increased as a result of excess intracellular FFAs and the influence of adipokines (leptin and tumor necrosis factor alpha (TNF-α). Excess of oxidative stress produces free radicals which in turn induces inflammation and cellular necrosis. Tissue inflammation stimulates the stellate cells to produce collagen.