DISCUSSION:

Liver enzymes elevate in liver injury in diabetic and non-diabetic conditions because they are responsible for glucose metabolism and energy is derived in this way. Glucose is transported into the liver cells by insulin. In response to this, liver enzymes elevate as anticipatory action such as GGT maintains the glutathione homeostasis, SGPT and SGOT take part in the production of -Ketoglutarate from amino acids to continue TCA cycle for energy generation because -ketoglutarate is one of the intermediates in TCA cycle. When liver enzymes fail to perform their function, hyperglycemia occurs. ALT and AST levels elevate in liver inflammation and injury. ALT and gamma GT levels elevate in billiary tract obstruction. AST can also rise due to asymptomatic NAFLD. AST is less specific because it is elevated in response to hyperlipidemia and person with BMI 25kg/m2 Elevated GGT leads to decrease in insulin activity but GGT can also get elevated because of drugs like barbiturates and phenytoin, stroke and cardiovascular diseases. A study was conducted previously at WOSCOP in moderately hyperlipidemic patients which showed that elevated ALT level lead to diabetes. Increase in ALT thrice than normal is not a contraindication to start any oral anti-diabetic drug, it was further proved that improved glycemic control and decreased ALT is achieved in patients who were taking anti-diabetics. Therefore elevated levels of ALT and GGT chronically leads to diabetes therefore it can be used in future as predictor marker for diabetes mellitus, hence this study also tells us that patients with chronic inflammation of liver such as hepatitis B and C are most likely to develop diabetes in future.

Elevated liver enzymes produce oxidative stress by suppressing the activity of Insulin which in turn leads to hyperglycemia. One of the main functions of the liver is to maintain the sugar level in the blood. A sluggish liver fails to do so, and would fluctuate the sugar levels to a great extent.