Managing MASH When You Have Diabetes

Written by Rachel Reiff Ellis
Medically Reviewed by Shruthi N, MD on September 25, 2025
7 min read

Living with diabetes often means carefully managing your condition every day. If you also have a serious form of fatty liver disease called metabolic dysfunction-associated steatohepatitis (MASH), you may wonder how you’ll take care of both and do it well.

A great first step is learning how the two conditions are connected. Find out what actions you can take to slow down liver damage and feel better day by day.

MASH is a liver disease where too much fat builds up in your liver. It’s an advanced form of metabolic dysfunction-associated steatotic liver disease (MASLD). 

MASLD used to be called nonalcoholic fatty liver disease (NAFLD). It’s a range of conditions marked by extra fat in liver cells that isn’t caused by alcohol.

It’s normal for your liver to have some fat. But once more than 5% of your liver becomes fat cells, you get diagnosed with MASLD. The extra fat can cause liver cell inflammation and damage — a condition called hepatitis.

“MASH is not just about fat sitting in the liver,” says Neha Jakhete, MD, gastroenterologist and hepatologist at University of Maryland Medical Center in Baltimore. “The problem comes when that fat causes inflammation and injury to the liver cells."

Over time, this inflammation and damage can cause scarring, called fibrosis. And if the fibrosis is serious, scar tissue can replace a lot of your liver’s healthy tissue --- it's called cirrhosis. "That’s when we worry about long-term damage,” says Jakhete.

You can have MASH for years without knowing it. This “silent” progress is one of the most challenging parts of MASH. You may not realize your liver is under strain until tests show signs of inflammation or scarring.

Your chances of getting MASH are higher when you have type 2 diabetes, and vice versa. That's because both conditions share a common root cause: insulin resistance.

Your body uses the hormone insulin to control the amount of sugar in your blood (blood sugar levels). 

Insulin resistance means your body has stopped reacting to insulin the way it should. This makes your glucose (blood sugar) rise.

You body can get stuck in a loop that worsens over time:

  • Fat buildup causes liver inflammation.
  • Liver inflammation makes insulin resistance worse.
  • Higher insulin resistance makes it harder to control your blood sugar.
  • Poor blood sugar control makes liver inflammation worse.

“Diabetes and MASH are really two sides of the same coin,” Jakhete says. “Both stem from insulin resistance, and when they occur together, they amplify each other’s effects.”

“Poor glucose control doesn’t just affect your blood sugar — it feeds into liver inflammation,” Jakhete says. “And untreated liver inflammation makes it harder to manage blood sugar. They fuel each other.”

That cycle can sound discouraging. But it also means that many of the steps you take to manage one condition can benefit the other.

Your health care team will help you come up with a plan to treat your diabetes and MASH.

Your doctors may include:

  • Primary care physician to coordinate your overall health
  • Endocrinologist who specializes in diabetes care
  • Hepatologist or gastroenterologist to monitor and treat liver disease
  • Dietitian to help with nutrition counseling tailored to both conditions

“It’s really important to have a team approach,” Jakhete says. “People do best when their endocrinologist, hepatologist, and primary care provider are all communicating with each other.”

Your doctor will use specific tests to confirm a diagnosis of diabetes or MASH.

Diagnosing diabetes

There are many tests that can tell your doctor how your body handles glucose. 

Fasting blood glucose. This blood test measures your blood sugar after you haven’t eaten for some hours to see if it’s too high.

Oral glucose tolerance test. With a higher than normal fasting glucose, you’ll drink a sugary drink, and your blood sugar will be tested at regular intervals over the next two hours. 

Hemoglobin A1c (HbA1c). This blood test not only diagnoses but also tracks your diabetes over time because it can measure your average blood sugar over the last three months.

Diagnosing MASH

Your doctor will use a variety of tests to look for signs of inflammation and predict how much scarring is in your liver.

Bloodwork. These blood tests check for higher-than-normal liver enzymes, called liver function tests (LFTs). They’ll also test your blood fats to rule out other conditions.

Imaging tests. Special ultrasound, MRI, or FibroScan (a special type of ultrasound) measure stiffness and scarring in your liver. 

Liver biopsy. This uses a needle to take a small piece of liver tissue to test under a microscope for signs of inflammation and scarring. 

Because both conditions overlap, doctors often suggest that anyone with diabetes also get screened for liver disease, even if there are no symptoms.

Taking care of yourself with MASH and diabetes often means adding medical treatments, lifestyle changes, and support.

Medical treatment for diabetes and MASH

Although MASH and diabetes are two different conditions, common links can mean using fewer medications that benefit both conditions.

Keeping the blood sugar as close to normal as possible is a main goal for people with diabetes.

So, you may be taking:

The main goal of MASH treatment is to lower your liver fat and inflammation and avoid further scarring (fibrosis). 

There are two FDA-approved medications for MASH that your doctor may prescribe:

  • Resmetirom (Rezdiffra), a tablet you take by mouth once a day
  • Wegovy, a semaglutide you take by injection once a week

You and your doctor will come up with the best treatment plan for your health. Your plan may change over time based on test results, symptom changes, or new medication options.

Medications are vital to control your blood sugar and liver health. But the choices you make about diet, exercise, sleep, and stress can also have a powerful effect.

Healthy diet for MASH

What you eat can greatly affect both MASH and diabetes. Research shows that the Mediterranean diet can help you control your blood sugar and improve liver health.

This means that you can:

  • Fill up with vegetables, fruits, and whole grains.
  • Limit animal-based foods high in saturated fats (red meat or whole-milk dairy products).
  • Lean heavily on plant-based foods such as beans, legumes, and nuts.
  • Cook with healthy fats such as olive oil.
  • Choose whole foods as often as possible, and limit processed foods.

Physical activity

Exercise can improve your insulin sensitivity and lower liver fat. Aim for 150 minutes of moderate activity per week, such as brisk walking or cycling. Even a short, 10-minute family walk each day can help you get active and feel better.

“Movement is medicine,” Jakhete says. “Even a 10-minute walk after meals can improve blood sugar and help the liver.”

Strength training at least twice a week adds extra benefits for glucose control. In fact, resistance bands can help you build muscle and boost your metabolism.

Sleep and Stress

Poor sleep and chronic stress can make both MASH and diabetes worse. That’s because both raise your insulin resistance and inflammation. 

Follow these tips for good sleep hygiene:

  • Set a bedtime and wake time, and stick to them.
  • Keep your bedroom cool, dark, and free from distractions such as screens.
  • Create a calming wind-down routine before bed.
  • Avoid heavy meals, caffeine, alcohol, or strenuous exercise close to bedtime.

Try stress-lowering methods such as:

  • Mindfulness
  • Meditation
  • Yoga
  • Tai chi
  • Deep breathing exercise
  • Guided relaxation
  • Keeping a journal

Changing many habits at once can feel tough. So, start with small changes and build from there.

Break your goals into small steps that you can do.

Here are some tips to get started:

  • Instead of cutting out all sugar, start by lowering sweetened drinks.
  • Instead of jumping into a daily workout, try a 15-minute walk three times a week.
  • Track small wins, such as a lower HbA1c or better FibroScan score to stay motivated.

Living with both diabetes and MASH can make people feel stigmatized, especially since both are sometimes linked to lifestyle factors. This can affect your mental health, which is a crucial piece of your whole health.

Jakhete stresses that it’s important to remember that these are medical conditions rooted in biology, not personal failings.

“Shame and stigma can really get in the way of good care,” Jakhete notes. “People may feel blamed for having these conditions, but that blame is misplaced. Our focus should be on support and empowerment.”

Find support

Counseling, support groups, or online communities can help avoid isolation. Talking openly with trusted family or friends about your diagnosis can also help you feel less alone.

Remember that most of the strategies that help one condition also help the other and improve your overall health. Advances in medications, especially diabetes medicines that benefit the liver, are improving every year.

“You’re not powerless,” Jakhete says. “By working with your care team, staying engaged in your treatment, and making sustainable lifestyle changes, you can absolutely take control of your health.”