Diabetes and Diarrhea - We Should Really Talk About It

What can you do to balance your blood sugar and keep diabetes diarrhea at bay? Most people have experienced the unpleasant phenomenon that is diarrhea at one point or another in life. But while they may suffer for a day or two, then return to regular function, for people with diabetes, this is not always the case. In fact, approximately 22 percent of people with diabetes suffer from frequent bouts of diarrhea, with some cases leading to sleep disruptions and daily life dysfunction. This is because diabetes, when not under proper management and control, has a wide range of complications and effects that can lead to the onset of diarrhea. And, unfortunately, even when your blood sugar levels are adequately managed by conventional medications, you can still experience diabetic diarrhea, as it is a common side-effect of some of the more popular medical treatments.

Gastrointestinal complications of diabetes

Of all the complications of diabetes, gastrointestinal complications are the most challenging, and irksome you will have to contend with. These can include esophageal dysmotility, gastro-esophageal reflux disease (GERD), gastroparesis, enteropathy, non-alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy and diabetic diarrhea - the latter being a major player. While ostensibly difficult to distinguish from irritable bowel syndrome, diabetic diarrhea can alternate with constipation and/or normal bowel functioning. But when it does rear its nasty head, it can keep you awake, and even result in stool incontinence. When these complications turn into large bowel dysfunction, they fall under the umbrella of diabetic enteropathy.

Causes of diarrhea in people with diabetes

Diabetic enteropathy is characterized by:
  • A feeling of fullness after eating
  • Nausea
  • Abdominal pain
  • Bloating
  • Diarrhea and/or constipation
Yet, no single phenomenon has been pinpointed as the direct and unanimous cause diabetic enteropathy in general, or diabetic diarrhea specifically. Here are some potential causes:
  • High blood sugar levels can lead to nerve damage in the digestive system, which can cause diabetic enteropathy.
  • High presence of sugar in the blood can lead to slower digestion, which can enable bacterial overgrowth, leading to diarrhea symptoms.
  • People with diabetes are more likely (than people without diabetes) to also suffer from celiac disease. They can unknowingly ingest gluten and subsequently experience stomach aches and diarrhea.
  • People with diabetes are more susceptible to exocrine pancreatic insufficiency (EPI). Not enough digestive enzymes are produced by the pancreas, disrupting digestion and causing diarrhea.
  • Some diabetes medications are known to have diarrhea as a side effect when used long-term. These include popular treatment metformin, as well as GLP-1 receptor agonists, DPP-4 inhibitors, and statins.
  • Sorbitol and other sugar alcohols, commonly in “diabetic approved foods,” can have a laxative effect, causing diarrhea.

Tips for coping with diabetic diarrhea

First, make an appointment with your family doctor to determine whether antibiotics are needed, your medications or dietary habits should be modified, or you should be taking Lomotil or Imodium to settle your bowels and prevent future attacks. Second, it is extremely important that you control your blood sugar levels to help prevent diarrhea and subsequent damage from worsening. Adopting a BRAT (Bananas, rice, apples, toast) diet and increasing your water intake can help balance your glucose levels, prevent dehydration and firm your stool. If you would like to talk to other Type 2 Diabetics and hear about their experience, we recommend joining our Facebook Community Group.