The hepatitis C virus (HCV) spreads through contact with blood. It can cause an acute or chronic infection. If HCV becomes chronic, it can contribute to liver damage and the development of other conditions, including diabetes.

Numerous studies show a correlation between HCV and diabetes. Up to 33% of individuals with chronic HCV also have diabetes.

In this article, we will look at the link between hepatitis C and diabetes, including the relationship between the two conditions, their treatment, and management.

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According to a 2017 study, people with chronic HCV have an increased chance of developing type 2 diabetes and insulin resistance in comparison with people who do not have the virus. They are also more likely to develop diabetes than people with hepatitis B, which is another virus that affects the liver.

To understand how HCV can contribute to diabetes, it is important to understand how it develops.

When a person eats carbohydrates, the body converts them into glucose. That glucose enters the bloodstream. Increased amounts of glucose in the bloodstream then trigger the release of insulin from the pancreas. This insulin then helps cells absorb the glucose and use them as energy.

If there is more glucose in the blood than the body currently needs, it gets stored for later use by the liver. However, if the liver is not functioning as it should be due to a HCV infection, it cannot perform this task as well as usual. This leads to high blood glucose levels.

There are several ways that HCV can impair liver function in a way that contributes to diabetes, according to a 2015 review. HCV may cause:

  • chronic inflammation
  • steatosis, which occurs when fat builds up in the liver
  • liver scarring (cirrhosis), which reduces liver function
  • hepatocellular carcinoma, a type of liver cancer

These conditions impair the liver’s ability to remove excess glucose from the blood. It may also impair the release of insulin, further raising blood glucose levels. Over time, this can result in type 2 diabetes.

Some research suggests that there is a higher prevalence of HCV among people with diabetes. However, it is unclear why this is the case.

A 2019 study from Brazil found that people who had lived with diabetes for more than 5 years had a greater likelihood of also having HCV. The 2015 review notes that previous studies from the United States, Taiwan, and Italy also found that HCV was more common among those with type 2 diabetes.

The reasons for this remain unclear, but it could be due to increased exposure to the use of needles during emergency situations. More research is necessary to understand the link.

Individuals with diabetes must maintain balanced insulin and blood sugar levels to manage the condition. This is known as maintaining glycemic control. Normally, people achieve glycemic control by carefully monitoring their insulin and blood sugar levels, and by receiving insulin injections.

Research from 2017 states that a HCV infection can decrease glycemic control, which can worsen diabetes. However, the researchers found that people with both HCV and diabetes who received successful antiviral treatment improved significantly, and required less insulin as a result.

While diabetes does not have a cure, HCV is highly treatable. Doctors typically prescribe direct acting antiviral (DAA) medications for HCV, which successfully remove the virus in over 90% of cases with few side effects. Most courses of treatment last from 8–12 weeks.

Early testing and treatment for HCV is important, especially for those who either have, or are at risk for, diabetes. However, DAA treatment may cause changes in insulin or blood sugar levels as the virus clears, which could result in unexpected symptoms.

For this reason, people with HCV and diabetes should carefully monitor their blood sugar levels during HCV treatment, and alert a doctor immediately if they experience the symptoms of high or low blood sugar levels. If DAA treatment improves their diabetes, they may need to adjust the amount of insulin they take.

Whether a person is undergoing HCV treatment or not, managing diabetes can be more complicated if someone has the virus, due to its impact on the liver.

People with chronic HCV and diabetes have an increased risk of developing long-term complications, including cirrhosis.

Cirrhosis occurs when an overtaxed liver attempts to heal itself. As it tries to repair any damage, the liver forms scar tissue. The scar tissue decreases liver function and can cause liver failure. If this occurs, the only cure is a liver transplant.

Other complications of cirrhosis include:

There are a number of behaviors people who have both diabetes and HCV can adopt to manage their conditions and reduce the risk of complications. Some of these changes may also help reduce the chance of developing diabetes in the first place.

Steps people can try include:

  • avoiding alcohol, as it can damage the liver
  • eating a balanced diet that is low in sugar, fat, and salt
  • maintaining a moderate weight
  • quitting smoking
  • getting regular exercise of at least 30 minutes per day on most days
  • getting vaccinations for hepatitis A and B
  • getting tested for HIV, as having both HCV and HIV increases the likelihood of cirrhosis

Because HCV spreads through contact with blood, it is important for people with diabetes to dispose of sharps, such as needles, in a secure sharps container. Never share needles or blood glucose monitors with others.

Anyone with HCV and diabetes should contact a doctor about receiving antiviral treatment. If someone with HCV is concerned that they might have diabetes, they should also speak with a doctor as soon as they can.

The symptoms of diabetes can include:

  • fatigue
  • increased thirst and frequent urination
  • excessive hunger
  • unexplained weight loss
  • blurry vision
  • irritability
  • frequent skin infections
  • slow-healing wounds

If someone with diabetes and HCV develops any of the following symptoms, dial 911 or the number of the nearest emergency department:

  • unusual bleeding
  • yellow skin (jaundice)
  • confusion
  • excessive drowsiness
  • swelling in the abdomen or legs
  • fruity-smelling breath
  • difficulty breathing

Chronic HCV infection can increase the risk of someone developing diabetes. This is due to the virus’s impact on the liver, which is involved in storing glucose. If the liver cannot function as it should, it can lead to high blood glucose levels and insulin resistance.

Due to the correlation between HCV and diabetes, doctors should regularly test people with HCV for diabetes. The best way to reduce the risk of HCV-related diabetes, and to prevent the virus from worsening pre-existing diabetes, is to treat the infection as soon as possible. Successful treatment may result in improved glycemic control.