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Diabetes Disruption: Going Too Much or Too Little?

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What to know about diabetes-related diarrhea and constipation

If you have diabetes — either type 1 or type 2 — you know how important it is to manage your blood sugar levels. The disease can affect your whole body, from your head (raising the risk of stroke) to your toes (increasing your chances of serious foot wounds), if blood sugar levels aren’t well controlled.

Another part of the body that diabetes can affect is the digestive system. About 60% to 70% of people with diabetes experience digestive problems, such as diarrhea or constipation, that can disrupt their daily lives.

As a gastroenterologist at the Temple Digestive Disease Center, I treat many patients who experience diarrhea or constipation triggered by their diabetes. But I know that many more people with diabetes experience these conditions and don’t get the help that they need. Here’s how diabetes-related diarrhea or constipation can develop — and what you can do if you have them.

The link between diabetes and digestive issues

Throughout your body is a network of nerves that do things like tell your heart how fast to beat, or tell your stomach how to digest food. Over time, high blood sugar levels from diabetes can damage these nerves — a condition called diabetic neuropathy — and cause problems in places like your legs, eyes, and feet, and your internal organs, including those in your digestive system.

Nerve damage in the digestive system can trigger a variety of symptoms, such as vomiting, problems swallowing, and bloating. However, the most common symptoms I see in patients with diabetes are constipation, diarrhea, and diarrhea alternating with constipation.

I tell my patients that the nerves in the digestive system work kind of like a car. Some nerves are the gas pedal, and they tell the system to move food through. Other nerves are like the brake pedal, and they tell the system to slow down. But if these pedals get damaged, food doesn’t move through the way it should. Perhaps too many braking signals cause constipation. Or an unrestrained “go, go, go” signal could lead to diarrhea.

This is obviously an oversimplification. Diabetic bowel disorders are actually quite complex, and nerve damage isn’t the only problem. In addition to neuropathy, common diabetes medications can trigger bowel problems. Oral medications like Metformin are frequently used to treat diabetes. But this well-known medicine is known to cause diarrhea. For most people, this side effect goes away a few days after starting the medication. But for others, it can be a lasting problem. Some sugar substitutes can also cause diarrhea.

Our research shows that although many people with diabetes have constipation or diarrhea, they are often embarrassed to talk about their symptoms. Things like urgency, incontinence, and waking to find you’ve soiled yourself may be challenging to discuss, but they are common problems in people with diabetes, and they can be treated.

When to see a specialist

I strongly urge anyone who has diabetes and is struggling with diarrhea, constipation, or both, to make an appointment with a gastroenterologist. Diarrhea can be a sign of infection, so people with significant diarrhea should seek help. With constipation, it depends on how much it’s bothering you. If you’re backed up a day or two each month, it may be something you can just live with. But if you go five or more days without a bowel movement, you should absolutely seek the help of a gastroenterologist.

When someone comes to see me, the first thing I do is make sure the problem isn’t caused by an infection or some other condition. Then, I’ll work with the patient to develop a treatment plan. There are a number of medications I can prescribe to help ease gastrointestinal disorders in people with diabetes.

What you can do to help manage bowel problems

Beyond taking medications, there are a number of lifestyle changes you can make to help manage diabetic constipation and diarrhea. First and foremost, keep your blood sugar levels on target as best you can. Secondly, talk to your care team about all of the medications and supplements you currently take. We can work with you to minimize or eliminate those that contribute to bowel discomfort.

Other, small changes can make a difference too. Increased physical activity can help if you’re constipated. And what you eat obviously has an impact. Keep in mind that artificial sugars can cause diarrhea. Even a single hard candy with artificial sugar can trigger loose bowels. Keep track of what sweeteners you’re ingesting and how they affect your symptoms.

Finally, I encourage my patients with diabetes to increase the amount of fiber in their diets. People dealing with constipation sometimes expect to hear this advice. But, surprisingly, fiber can be advantageous for people with diarrhea as well. More fiber bulks up the stool and makes it less loose. If there’s any magic treatment here, it’s fiber.

Get the digestive help you need

No matter what kind of bowel problems you’re experiencing, the board-certified gastroenterologists at the Temple Digestive Disease Center are here to help.

Request an appointment online with a Temple gastroenterologist or call 800-TEMPLE-MED today.

Helpful Resources

Looking for more information?

Zachary Wilmer Reichenbach, MD, PhD, PHP

Dr. Reichenbach is the Director of the Translational Research Program in Gastroenterology and the Assistant Professor of the Center for Substance Abuse Research (CSAR) at the Lewis Katz School of Medicine at Temple University. He strives to provide comprehensive, high quality patient care by taking time with patients to understand their problems and thoroughly review their medical history to create personalized treatment plans. By doing so, he is able to optimize outcomes for patients.

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