Liver ALT AST and GGT levels

[Essex]

Hi

I was diagnosed due to HbA1c blood tests taken in consequence of trying to find out why my liver AST and ALT enzyme levels were high

I am learning lots from this forum, but am still finding my way on how the liver-pancreas work together for BG regulation, etc

Am I correct in thinking that if (for whatever reason) my BG has been too high (which it has) then the liver will make more AST and ALT enzymes to try to convert the Glucose to Glycogen and so lower the BG level?

My ALT and AST levels reached a peak of around double the max values which I have just read is only 'mildly elevated' (very high values are 50 times max values apparently). That was reassuring. My ALT is about twice my AST as well, so not too disturbing.

Could this be what's been happening in me - the ALT and AST values were elevated due to high BG levels, and the liver uping enzyme production trying to bring it down?

[I have a history of alcohol abuse, as I see it now, but it was heavy social drinking rather than full-on alcoholism - I could go a long time without a drink, but when I got going.... Also being 5'3 and drinking with people twice my size prob didnt help none! I have pretty much given up now for a number of years - although I enjoyed some very nice Portuguese red wine with meals to a controlled excess over the festive period (i.e. nothing like I would have done before 😳).]

There is a very suspicious correlation between the timings of my HBA1c and liver enzyme peaks around Jan 2021 in the two graphs below .....





Although I generally don't tend to use non NHS / DiabetesUK sites, I found this helpful:

What Do AST and ALT Test Results Mean?

Blood tests for the liver enzymes AST and ALT can provide insight into liver health. Here's when they're needed and what high levels mean.

www.verywellhealth.com

 

[Robin]

When I was first diagnosed, my ALTs were extremely high. As was my HbA1c. I was misdiagnosed as Type 2 to start with because of my age, and my GP chased the red herring of Fatty Liver disease, sending me for an urgent liver ultrasound. Which showed I had a perfectly healthy liver.
When I was seen by the hospital consultant three months later, and my BG levels had started to come down a bit, a second set of liver function tests came back all within normal ranges, and the consultant said that my liver had just 'Got angry' about the high blood glucose. He didnt go into technical detail, and I didn’t ask, as there was so much else to discuss during the consultation (Like, how I was really Type 1 and needed insulin!)
So, long story short, yes your high blood glucose can upset your liver, but I don’t know the science behind it!

 

[Essex]

Thanks @Robin
I will bring it up when I see my liver doctor soon

 

[Essex]

@Robin
I just saw my 'liver' (part of 'internal medicine' here) doctor and she said that the reason why she sent me to the diabetes specialist doctor (dont know what that is called!) was because raised ALT and AST levels are an indicator of diabetes.
She also confirmed my hypothesis that if BG is high then more ALT & AST enzymes are made to try to bring it down via 'warehousing' it as Glycogen.

Great Doctor, also 'cured' my acid reflux by pointing out my lactose intolerance (gas production pushes acid up) and said that my weight loss had helped in that respect too - A previous doctor said that my hiatus hernia was the only reason for that and that I would now have to take pantoprazole forever - WRONG!

 

[Maca44]

A Liver scan should also be done as this will also raise ALT

 

[Essex]

A Liver scan should also be done as this will also raise ALT

Thanks.
I have had scans before - I had (have?) a slightly fatty liver that seemed to be getting better between scans
In the recent appointment with my doc (she is great!) I got a new scan booked with some new fangled scanner that can distinguish much better between fat and fibrous etc apparently (my doc is very excited about the new machine!)
Ive also had the hep test, and I forget what else

 

[Maca44]

That all sounds good 🙂

 

[Hepato-pancreato]

Had every liver scan going. Have regular ultrasound at 6 month intervals (surveilance). Due to cirrhosis. Was a heavy drinker no such thing as an alcoholic. ( i went to windsor clinic in liverpool). Had hepatitis c now cured after ovef 30 years. Had liver cancer last year. My last lfts were good. Had most of my pancreas removed. My specialist says the liver can stand loads of hammer like mines had. Just stay off the sherberts eat healthy and you'll be fine. Also have a positive mental attitude.

 

[Flutterby]

Hi Essex, I've been type 1 over 40 years but out of the blue in 2021 I had raised liver enzymes at similar levels to yours. I have had 12 months of scans and blood tests and some antibodies were discovered. My liver function has since returned to normal but it took several months. There has been a big debate around whether the covid vaccine might have triggered all this and I am trying to decide how to proceed. Originally doctors told me not to have a booster but then they backed out and said have it! I am interested in your journey and wonder whether there is any correlation between when you had a vaccine and these results as there was with me.

 

[Essex]

Hi @Flutterby
This started long before any COVID vaccinations (I've had 3 Pfizers)
My levels obviously got much better when I stopped the usual English abuse of alcohol, but that was quite a few years ago now
There was a definite correlation between my enzymes and HbA1c peaks tho (see plots below)

This was around the time I started to take escitalopram for my anxiety and depression and so I calmed down and enjoyed life again, and put on weight 63 to 73 kg (5'3"), so not too much but enough. I was also eating loads of carbs and sweet Portuguese pastries and everything really, and pretty much the only fruit I'm not allergic to (Oral Allergy Syndrome / Pollen Food Syndrome) is bananas
three times enzyme levels is nothing anyway apparently, as long as you check that its not an indication of the usual suspects. Sure your Docs are onto that tho.
By the way, its possible I have no idea what I am talking about and have just fitted the wrong curve to the data.
But my Gastroenterologist (wow I spelt that right, 1st time!) seems to think that's what's going on too
All moving in the right direction now tho
I will go for new tests soon, will let you know

 

[Flutterby]

Thanks for your response. Initially GP thought it was fatty liver, consultant at QE hospital (Birmingham) laughed and said that was certainly not the case.

They did more bloods and found AMA antibodies, an indicator of Primary Billiary Cholangitis and yet scans are clear, I am symptom free so they are bemused.

I had just had a stroke in October 2020 and bloods were fine then. Vaccines in early March and abnormal LFT a few weeks after. Now I face a difficult decision with no certainty either way.

It sounds like your doctors are looking after you well so I wish you all the very best and will continue to be interested. It sounds like you have had lots going on.

I've had 2 Pfizer jabs. Take care of yourself.