Diabetes and digestive issues

People with diabetes have a higher risk of gastrointestinal (digestive) issues than those who don’t have the disease. It is estimated that up to 75% of people with diabetes report some form of digestive issue to their healthcare team, including difficulty swallowing, constipation, acid reflux, nausea, vomiting and diarrhea. Read on to learn more about diabetes digestive issues.

What is the connection between diabetes and digestive disorders?

It is well-known that type 1 and type 2 diabetes can affect any organ in the body, such as the heart, kidneys and eyes. However, diabetes can also affect organs in the gastrointestinal tract. Some digestive disorders may be caused by the same factors that lead to diabetes, including obesity and physical inactivity.

It is also thought that digestive issues are the result of diabetes-related complications, such as hyperglycemia (consistently high blood sugar levels). As well, the longer a person has had diabetes, the higher their risk of digestive issues.

Types of digestive disorders

Common types of digestive disorders in people with diabetes include:

• Gastroparesis (also known as delayed gastric emptying) is a disorder of the digestive tract that causes food to remain in the stomach longer than it should. Gastroparesis is common in people with diabetes. It affects between 27% and 58% of people with type 1 diabetes and 30% of those with type 2 diabetes.
• Celiac disease is a disorder that triggers an immune reaction in your small intestine when you eat foods containing gluten. Gluten is a protein found in wheat, barley and rye. People with type 1 diabetes have a higher risk of celiac disease than those who don’t have the condition.
• Gastroesophageal reflux disease (GERD), commonly known as acid reflux, happens when stomach acid frequently flows back into the esophagus (the tube that connects the mouth to the stomach). This back flow can irritate the lining of the esophagus. Many people experience acid reflux from time to time; however, GERD is defined as mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.
• Diabetic autonomic neuropathy affects the autonomic nerves, which control the bladder and intestinal tract. Paralysis of the bladder is a common symptom of this type of neuropathy. When this happens, the nerves of the bladder no longer respond normally to pressure as the bladder fills with urine, which can cause incontinence (leaking of urine). Autonomic neuropathy can also cause constipation or diarrhea.

Other gastrointestinal conditions that can occur in people with diabetes include:

• Yeast infections in the mouth (known as thrush), which cause pain and a burning sensation in the tongue and throat
• Yeast infections in the esophagus, which can cause heartburn, difficulty swallowing and bleeding
• Gastric ulcers, which are caused by a bacteria called Helicobacter pylori

Diabetes medications and digestive issues

Some diabetes medications can cause digestive issues, including:

• Metformin. While metformin is one of the most commonly used drugs to treat type 2 diabetes, it can have some effects on the digestive tract, including diarrhea, fecal urgency (the sudden need to rush to the bathroom to empty your bowels), nausea and abdominal pain. Most of these symptoms disappear as your body adjusts to the medication but, in some cases, diarrhea can last for a long time.
• Alpha-glucosidase inhibitors. These medications can cause gas, diarrhea, and stomach pain.
• DPP-4 inhibitors. These medications can cause upset stomach and diarrhea.

Food choices and digestive issues

If you are experiencing diabetes digestive issues, there are some food choices you can make, and eating habits you can adopt, to help relieve pain and discomfort. These include:

• Choosing high-fibre and high-fat foods less often, as they take longer to digest.
• Limiting intake of foods that contain sugar and refined carbohydrates, as they can interfere with gut bacteria (the natural bacteria found in the stomach and intestines that aid digestion and gastrointestinal health).
• Avoiding sweeteners known as “sugar alcohols,” as they can cause bloating and diarrhea. Sugar alcohols are found in many processed foods, including cookies, cakes, candies, chewing gum and soft drinks, as well as toothpaste and mouthwash. Sugar alcohols are known commercially under a number of different names, including sorbitol, maltitol and xylitol.
• Eating small, frequent meals throughout the day. This is especially beneficial for people who have acid reflux or gastroparesis.
• Trying not to lie down after eating a meal. Sitting upright, standing, or taking a walk after eating will prevent food and stomach acid from backing up into your esophagus and throat.

Are there ways to prevent digestive disorders?

The main things you can to do prevent digestive disorders are:

1. Control your blood sugar. Consistently high blood sugar levels can increase the risk of digestive disorders.
2. Eat healthy foods. A healthy diet will help keep your blood sugar under control and also help you avoid digestive disorders. Consider some of the food choices above.
3. Exercise regularly. Regular physical activity will help with food digestion, and also help with blood sugar and weight control.

If you have type 1 or type 2 diabetes, you may be at risk for digestive issues, especially if you have had the condition for some time. If you are experiencing gastrointestinal discomfort, make sure you speak with your diabetes healthcare team. They can diagnose any issues and ensure that you are properly treated.