We thank Prof. Al-Mendalawi for his valuable comments. Glycogen hepatopathy can occur anytime during the duration of diabetes in type 1 diabetes mellitus. 

T1DM-associated GH results from excess accumulation of glycogen in hepatocytes, frequently seen in unstable diabetic patients, where hyperglycemia is treated with supra-physiologic doses of insulin. Blood glucose passively enters the hepatocytes in which glycogen synthesis is promoted by high cytoplasmic glucose concentration reliant on the presence of insulin. Glycogen is then trapped within the hepatocytes as a result of a vicious cycle of hyperglycemia and insulin treatment.^1,2 

Diabetic patients with hepatomegaly and abnormal liver enzymes have often been assumed to have NASH rather than GH. A liver ultrasound is not helpful in distinguishing NASH from GH. Consequently, the condition often goes under-recognized with no further evaluation. GH is a liver condition with minor chance or no risk of progression to fibrosis and is reversible with euglycemic control.^1,3 

References

1. Munns CF, McCrossin RB, Thomsett MJ, Batch J. Hepatic glycogenosis: reversible hepatomegaly in type 1 diabetes. J Paediatr Child Health 2000;36:449-52. 

2. Torbenson M, Chen YY, Brunt E, Cummings OW, Gottfried M, Jakate S, et al. Glycogenic hepatopathy: an underrecognized hepatic complication of diabetes mellitus. Am J Surg Pathol 2006;30:508-13. 

3. Chatila R, West AB. Hepatomegaly and abnormal liver tests due to glycogenosis in adults with diabetes. Medicine (Baltimore) 1996;75:327-33.