Improper Insulin Compliance May Lead to Hepatomegaly and Elevated Hepatic Enzymes in Type 1 Diabetic Patients

We have encountered hepatomegaly and pronounced elevation of liver enzymes AST and ALT in four patients with type 1 diabetes. These patients shared similar clinical features. They were all female (aged 11–14 years) with poor glycemic control. All had frequent hyperglycemia and intermittent hypoglycemia related to their history of poor compliance. Most of them had multiple hospital admissions for severe hyperglycemia and/or diabetic ketoacidosis. In addition to their high daily doses of insulin (1.3–2.2 units · kg−1 · day−1), most were receiving extra doses of insulin to correct their frequent hyperglycemia. A1C levels were all higher than normal (ranging from 9.2 to 14.5%). Their initial AST and ALT levels were at least 30- and 14-fold higher than the normal limits, respectively, but the other liver function tests, such as alkaline phosphatase, prothrombin/partial prothrombintime, and total bilirubin, were normal except for one …