The most direct effect of diabetes on liver metabolism is the formation of a fatty liver. Under normal conditions, fat in the liver accounts for only 3-5% of the liver weight. if the fat in the liver exceeds 10% of the liver weight, or if histologically, the fatty liver parenchyma exceeds 30%-50%, it is called fatty liver. in type 1 diabetes, the degree of fatty liver is related to the degree of disease control; in type 2 diabetes, the degree of fatty liver is related to the disease duration and obesity. The incidence of fatty liver in diabetes has been reported to be 21%-78%. The etiology of fatty liver is related to the decrease of insulin. Insulin inhibits lipolysis. When insulin is deficient, the release of free fatty acids into the blood increases and hyperlipidemia is likely to occur. More free fatty acids enter the liver, synthesize triglycerides and store in the liver, forming a fatty liver. Hepatomegaly is more common in diabetic patients with poorly controlled diabetes mellitus and in pediatric patients. The histological changes are predominantly hepatic steatosis, including atrophy, degeneration and necrosis of hepatocytes. It is controversial whether diabetic fatty liver can develop into cirrhosis. Some scholars believe that the degree of hepatic steatosis in diabetic patients is not severe and can subside with diabetes control; others believe that fatty liver is one of the causes of cirrhosis. Hyperlipidemia often occurs in patients with either type 1 or type 2 diabetes if their blood sugar is poorly controlled. Patients with early-stage fatty liver have weakness, loss of appetite, and wasting as the main clinical manifestations. In ketoacidosis often the liver enlarges rapidly and sometimes even pain in the liver area occurs. Sometimes it can be misdiagnosed as hepatitis, but jaundice is less common, there is no fever, and liver function is not severely impaired. Children can have their development affected by hepatomegaly, but after insulin treatment, the liver size and liver function can return to normal with the correction of glucose metabolism. In patients with diabetic fatty liver, there is often significant elevation of blood glucose and elevation of triglycerides. The incidence of abnormal liver function is low and there may be mild hypoproteinemia and elevated globulin. Elevated alkaline phosphatase and ghrelin are also present and often return to normal as the disease is controlled. The diagnosis of the disease is based on a clear history of diabetes mellitus, weakness, loss of appetite, abdominal distention, discomfort or vague pain in the liver area, nausea and vomiting, and diarrhea, and in severe cases, jaundice, ascites, bleeding tendency, liver failure, and encephalopathy. In mild cases, the liver may be mildly enlarged, while in severe cases, splenomegaly, ascites and cirrhosis may occur. Liver function tests may include mild elevation of glutamate transaminase, mild hypoproteinemia and elevated globulin, increased alkaline phosphatase, and in severe cases, hyperbilirubinemia. Ultrasound and CT are helpful in the diagnosis of the disease, and liver biopsy is a characteristic basis for establishing the diagnosis. The treatment of the disease includes lipid regulating therapy, fatty liver treatment and Chinese medicine treatment. I. Lipid regulating treatment: 1. Diet therapy No matter patients with diabetes or combined hyperlipidemia, they need diet therapy first. The basic principle of diet is four low, that is, low fat, low cholesterol, low carbohydrate (low sugar), low calories. 2.Medication In general, patients with diabetes combined with mild hyperlipidemia do not need to be treated with lipid-lowering drugs, but only use glucose-lowering measures to correct abnormal glucose metabolism, which can gradually restore blood sugar to normal. However, for patients with plasma cholesterol >6.7 mmol/L, triglycerides >2.28 mmol/L, LDL >2.28 mmol/L or higher than HDL, if diet control is not effective, lipid regulators can be added appropriately. Commonly used drugs, such as niacin, Lipin, Lysergic, Lipocom, etc. Treatment of fatty liver Fatty liver can be treated by controlling blood sugar and diet to achieve certain results. Drugs can promote the oxidation and transfer of fat in the liver, and help the recovery of fatty liver. For those who have abnormal liver function and have not recovered from glucose-lowering treatment, liver-protective drugs and energy combination agents are given. Commonly used drugs, such as inositol, coenzyme A, adenosine triphosphate, etc. Chinese medicine treatment The disease belongs to the category of “thirst”, “accumulation” and “bulging” in Chinese medicine, and the four diagnoses should be taken together to identify and treat the symptoms. Commonly used prescriptions include Si Jun Zi Tang, Wen Gao Tang, Ping Gao San, Ba Zhen Tang, etc.