While anyone — with or without diabetes — can experience bouts of diarrhea, it can be the direct result of diabetes for some.
Also referred to as “diabetic diarrhea,” this is one of the lesser-known complications of diabetes, but it can be incredibly difficult to manage and live with on a daily basis.
It’s estimated that about 22 percent of people who have lived with diabetes for a while experience frequent diarrhea.
In this article, we’ll look at the causes, symptoms, and treatment options for diabetes-related diarrhea.
How does diabetes cause diarrhea?
Diabetic diarrhea is likely the result of longterm high blood sugar levels damaging the nerves and overall function within your colon, small intestines, and your stomach (a condition known as neuropathy).
“Many gastrointestinal complications of diabetes seem to be related to dysfunction of the neurons supplying the enteric nervous system,” explains the 2000 edition of Clinical Diabetes.
When the nerve fibers throughout your digestive system are damaged, this can result in constipation or diarrhea (often both) at different times because some nerves stimulate movement and other nerves help to slow movement in your intestines.
The bouts of diarrhea can be ongoing or they can persist for a few months and then quiet down for a few months. The phases of diarrhea can also be countered with phases of constipation, too.
Another possible cause of diabetic diarrhea is that people with diabetes are more likely to consume large quantities of artificial sweeteners and sugar alcohols, which are known to be potent laxatives.
Diagnosing diabetic diarrhea
There is no simple way to test and determine if the cost of your symptoms are related to nerve damage or something else.
If you suspect your diarrhea is directly related to your diabetes, schedule an appointment with your healthcare team, and keep careful notes for a week or two on the frequency and severity of your bowel movements.
Depending on their assessment, your healthcare team may refer you to a gastroenterologist for further investigation.
First of all, working with your healthcare team to improve your blood sugars is a crucial part of treating diabetic diarrhea.
Without addressing your blood sugars, you’ll continue to experience damage to the nerves throughout your digestive system (and entire body), and continue to experience uncomfortable symptoms.
Secondly, your doctor may advise you to change your eating habits. You may need to eat more fiber (or less fiber), drink more water, or include more (or less) vegetables in your diet.
Finally, there are a few specific medications being used to help patients counter the effects of this nerve damage and decrease or eliminate bouts of diarrhea:
- Parenteral somatostatin analog octreotide: For patients with longstanding diabetes and digestive complications, this option has proven useful. It is an injected medication that’s used primarily to treat different types of diarrhea.
- Selective serotonin 5-hydroxytryptamine type 3 (HT3) receptor antagonist: This is one type of 5-HT3 agonist, and it can be helpful in treating diarrhea. It can help with extreme nausea and vomiting, recurring diarrhea, or diarrhea related to chemotherapy, etc.
- Basic over-the-counter treatments: While there are a variety of over-the-counter options to treat general diarrhea, they aren’t as likely to work in a patient with diabetes struggling with severe nerve damage to their colon and overall digestive system.
Other possible causes of diabetic diarrhea
Aside from neuropathy within your colon, there are a few other things to consider when evaluating the potential cause of your digestive woes.
Metformin is one of the most prescribed drugs across the globe, and the first line of treatment for people with type 2 diabetes — but it can definitely upset your digestive system.
Actually, needing to “run to the bathroom” frequently while taking metformin is one of the reasons many patients stop taking it altogether.
The number one thing you can do to manage diarrhea resulting from metformin is to talk to your doctor about getting insurance approval for the more expensive “extended-release” version.
This is never the first version prescribed because it costs more, which means your health insurance will want you to first try the cheaper version.
If you report adverse reactions and your doctor documents this, you have a good chance of getting insurance approval for the extended-release version of metformin.
A diet high in sugar alcohols in “low-carb” products
If you’re eating a lot of low-carb protein bars, candies, ice creams and other processed products that use sugar alcohols as a sweetener, don’t be surprised if you’re running to the bathroom regularly.
Sugar alcohols are a known laxative. While most people can consume some sugar alcohol without much digestive trouble, most people will find that too much too often leave them dealing with stomach cramping, gas, and diarrhea.
Everyone has a different tolerance level for sugar alcohols. Approach these types of products with caution and take note of how your body responds to the different types of sugar alcohols and how often you’re eating it.
Celiac disease or gluten intolerance
While not as common as other conditions that often accompany diabetes, Celiac disease or an intolerance to gluten are frequent enough in the diabetes population that anyone with diabetes should consider it a possibility.
Celiac disease is an autoimmune condition, which means your immune system starts attacking your own body when gluten is present. This can be tested for with a simple blood test — but make sure you do not start eating a “gluten-free diet” until after you’ve had the test done, otherwise your results may not show signs of Celiac disease.
An intolerance to gluten is more like an allergy. When you eat gluten, you feel awful in any variety of ways. The only way to “test” for this is to completely remove gluten from your diet for at least 3 weeks, assess if your symptoms went away, then reintroduce it and assess if your symptoms return.
Symptoms of either condition can include: headaches, bloat, gas, tiredness, diarrhea, depression, brain fog, skin issues (eczema, acne, etc.), weight-loss, constipation, or foul-smelling stools.
Yeast infections in your GI tract
People with diabetes whose blood sugars are consistently high face a significant risk of yeast infections — including in your gastrointestinal tract. This overgrowth of yeast is the direct result of too much glucose in your bloodstream.
We need some yeast and bacteria in these areas of our body, but when blood sugars are consistently high, the excess glucose feeds the growth of the yeast.
Most likely, after being examined by your doctor, you’ll be prescribed an anti-fungal medication like nystatin, ketocanazole, or flucanazole to help kill the excessive yeast.
Fortunately, the treatment is highly effective and can resolve most yeast infections within a few days to a week. However, keep in mind that part of your treatment plan must include working to improve your blood sugar levels, otherwise, you’ll simply develop another yeast infection.
Irritable bowel syndrome
Irritable bowel syndrome (IBS) is an overarching diagnosis for a variety of symptoms related to your digestive system. It appears to be more common in the diabetes population but can develop in anyone.
The symptoms of IBS can include two specific details:
- Ongoing pain in your abdomen
- Frequent changes in your bowel movements (diarrhea, constipation, or both)
- Discomfort after eating (but unable to specify a consistent food item as a source of pain)
- Bloating and gas
- Difficulty sleeping due to overall discomfort
Testing for IBS is difficult. Instead, the diagnosis is usually the result of ruling out other options, especially Celiac disease or gluten intolerance. In people with diabetes, nerve damage within the colon and small intestine will be heavily considered, too.
A diagnosis of IBS is generally the result when it’s clear there are no other signs of damage or other conditions affecting any part of your digestive system.
The treatment for IBS can include some over-the-counter medications for constipation or diarrhea, but most likely, you’ll need to take good notes on what foods cause you the most pain, consider removing gluten from your diet as it causes a great deal of digestive inflammation in many, and improve the overall amount of whole foods (versus processed foods) in your diet.
For many, following a “low-FODMAP diet” can be tremendously helpful in improving IBS-related symptoms.
Probiotics — with your doctor’s support — can also help improve the beneficial bacteria in your gut which in turn helps improve digestion.
Stress can also play a major role in IBS. If you are under a great deal of stress in your life, consider this as a potential cause of your digestive upset and talk to your healthcare team about therapy, medications, and changes in your life to reduce stress and anxiety.
Simple steps to improve your digestive health
Digestive issues as people with diabetes are common — but there are so many things you can do to prevent and protect yourself, starting with improving your blood sugar levels, eating a diet consisting of mostly whole foods, and getting regular exercise.
Don’t forget to nix the cigarettes and keep alcohol beverages limited to a few times a week rather than every night.
Like many aspects of diabetes health, improving and protecting your digestion comes down to the simplest habits and choices we make every day.
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