The Link Between Hepatitis C Infections and Diabetes Mellitus

There has been quite a lot of discussion about a possible correlation between the transmission of the hepatitis C virus (HCV) and military immunizations performed with jet injectors. Hepatitis C virus is transmitted by blood. The risk factors for HCV are those that have had blood to blood exposures. Individuals born between 1945 to 1965 have a higher chance of being infected with HCV. This is because of a lack of a strict protocol for the handling and testing of blood and blood products during that time. Protocols for blood handling are constantly evolving to become safer and safer. Other risk factors exist for those that have tattoos/body piercings, are drug users, are on long term dialysis or have been diagnosed with liver disease.

What Is Hepatitis C Virus (HCV)?

HCV is an infection of the liver that is caused by the hepatitis C virus. According to the CDC, for the majority of patients, this becomes a serious disease. It is possible that infected individuals won’t show any symptoms or look ill. Out of the general population of the United States, about 3 million people are living with chronic hepatitis C. There is no vaccine for HCV at this time. Symptoms of HCV infection include fever, fatigue, dark urine, clay-colored stools, stomach pain, loss of appetite, nausea, vomiting, joint pain, and jaundice.

Risks of Chronic HCV Infections

If left untreated, an HCV infection can cause some serious conditions. The condition can also develop into chronic hepatitis C virus infection, which is the case for many patients. And chronic hepatitis C may lead to a number of complications. These can include liver cancer like hepatocellular carcinoma, which is the most common type of liver cancer. Individuals with chronic hepatitis C can also experience liver cirrhosis, which is the gradual scarring of the liver tissue, as well as steatosis or the fatty infiltration of the liver. Some chronic hepatitis C patients with severe liver damage will eventually require a liver transplant.

Patients diagnosed with hepatitis C can take antiviral medications to control the virus. This antiviral treatment works by preventing the hepatitis C infection from multiplying in the body. Most doctors prescribe these antivirals to be taken once per day. Two of the main medications that doctors prescribe for hepatitis C infection treatment are called Harvoni and Sovaldi. Some patients may take these prescriptions with an antiviral called ribavirin. Hepatology specialists will recommend a set of medications based on a patient’s specific needs.

It’s important to note that this discussion only refers to the hepatitis C virus. There are several other types of viral hepatitis. The hepatitis A virus (HAV) and hepatitis B virus (HBV) are two of the most common types of hepatitis worldwide. However, there are available vaccines for HAV and HBV, while there is not a vaccine for HCV.

What Is The Link Between HCV And Type 2 Diabetes?

It is important for patients to know that having a diagnosis of HCV also puts them at an increased risk for developing diabetes mellitus (DM).  This is true for both type 2 diabetes and type 1 diabetes. Individuals who already have diabetes may also experience more severe symptoms with a hepatitis C infection. The combination of HCV and DM will lead to increased HCV symptomology, and it will increase the odds of developing liver damage. Type 2 diabetes and prediabetes can also be risk factors for fatty liver disease.

If you have HCV, the first sign of DM development is called insulin resistance. When you eat your body breaks food down into smaller components of nutrients; one of those nutrients is glucose. Glucose needs insulin in order to be absorbed by the body, especially into the liver where glucose is stored. Insulin resistance prevents your body from absorbing glucose into your cells so it just stays in the blood. If this happens enough, your blood sugar remains high, which is called hyperglycemia, and you develop DM. This causes damage to your liver over time. So, in turn, you are at a higher risk for cirrhosis, liver failure, and liver cancer. The only way to know if you have insulin resistance is through a blood test. Insulin resistance is often the first sign of diabetes mellitus, and some people with insulin resistance are considered to have prediabetes. A medical professional can assess your fasting glucose levels to determine whether your blood glucose indicates prediabetes or signs of hyperglycemia.

Managing The Effects of Viral Hepatitis C And Diabetes

To mitigate the risk of developing DM, you should treat insulin resistance immediately. If you already have DM and HCV, managing it closely is the key to also managing the long term effects of each.  So proper diabetes care and management of your hepatitis C infection are key. Watching your diet, practicing glycemic control, monitoring blood glucose levels, taking your antiviral and diabetes medications (like metformin), eliminating alcohol intake, and losing weight are all ways to help manage your diseases effectively.

Diabetic patients and those who are at an increased risk for diabetes can talk to their doctor about lifestyle changes. A higher body mass

index (BMI) can lead to more diabetes complications and may put an individual at increased risk for developing type 2 diabetes mellitus. Family history can also play a role in personal risk for diabetes.

The cause of the impairment of the glucose-insulin mechanism in HCV patients is unclear but research continues to be conducted to ensure more effective treatment.

What Does This Mean For Veterans?

VA has specific guidelines for veterans with hepatitis C. Certain veterans may be at higher risk for having HCV, since VA has made a connection between the virus and jet injectors. Veterans may be at higher risk for military-related blood exposures as well.

VA recommends testing HCV infection testing for all individuals between 1945 and 1965. There are also certain risk factors pertaining to veterans. VA recommends testing for former military service members with risk factors such as the following:

• Has ever used a needle to inject drugs
• Had an organ transplant or blood transfusion prior to 1992
• Served in the Vietnam war or is a Vietnam-era veteran
• Has piercings or tattoos
• Was a healthcare worker who may have been exposed to blood
• Has HIV
• Had blood-to-blood exposure during military service

Keep in mind that you don’t need to have a specific risk factor or suspected case of HCV to be tested. Anyone who wishes to be tested for the hepatitis C virus should seek testing.

If you are diagnosed with the hepatitis C virus, VA can offer a special care service. They provide patient education, anti-HCV medication or medication for complications of HCV, access to medical care specialists, support groups, web-based resources, and more. VA closely monitors recent studies on viral hepatitis C to offer the best possible resources to affected veterans. Your local VA office can likely give you information on treatment for the HCV infection.

Va Ratings of Hepatitis C

Viral hepatitis C is included in VA’s 38 CFR § 4.114 ratings schedule, along with other diseases of the digestive system. VA grants ratings based on the severity of hepatitis C. The ratings are listed verbatim:

• 0%: Non-symptomatic
• 10%: Intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period
• 20%: Daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period
• 40%: Daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period
• 60%: Daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly
• 100%: Near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)

VA has a different rating system for diabetes mellitus, which may affect Vietnam-era veterans in particular. If your claim for VA benefits for hep C and diabetes is denied, contact the team at Hill & Ponton today. Our knowledgeable attorneys are proud to offer a free case evaluation to assess your claim today.