Types 2 diabetes is a condition affecting millions of people worldwide. It is a disease of high blood sugar in which the body becomes more resistant to the effects of insulin in the body, which is responsible for moving sugar (glucose) out from the bloodstream and into the cells. It has been observed that people with diabetes often have gastrointestinal issues. Many of these gastrointestinal issues are caused because of the nerve damage from chronic high blood sugar. Here’s the link between type 2 diabetes and gastrointestinal issues.
Link Between Type 2 Diabetes and Gastrointestinal Issues
Type 2 diabetes is the most common form of diabetes, affecting nearly 90 percent of people with diabetes.(1) This is a disease of high blood sugar or blood glucose. When you have type 2 diabetes, your body starts becoming more and more resistant to the effects of insulin.(2,3)
Insulin is a hormone that is responsible for moving sugar (glucose) out of the bloodstream and into the cells of the body.(4,5) Over time, persistently high levels of blood sugar can cause damage to the tissues and organs throughout the body. This damage also affects the gastrointestinal tract.
Nearly 75 percent of all people with diabetes are known to experience some or the other type of gastrointestinal condition.(6) Some of the common symptoms of digestive problems in people with type 2 diabetes include:
Many of these digestive problems are due to the nerve damage caused by persistent high blood sugar levels, a condition known as diabetic neuropathy.(7,8)
When high blood sugar causes damage to the nerves, the stomach and esophagus are unable to contract properly as they should for pushing food through the gastrointestinal tract. Apart from high blood sugar, some of the medications used for treating diabetes are also known to cause digestive issues.
Here are some of the gastrointestinal issues linked with type 2 diabetes.
Heartburn/Gastroesophageal Reflux Disease (GERD)
When we eat food, it travels down from the esophagus to the stomach. In the stomach, the acids break down the food. There is a bundle of muscles located at the bottom of the esophagus that prevents the stomach acids from going out of the stomach.
Gastroesophageal Reflux Disease (GERD), these muscles at the bottom of the esophagus become weak, allowing the acid to rise up into the esophagus. This acid reflux causes burning and pain in the chest and throat and is known as heartburn.(9)
People with diabetes are at a higher risk of experiencing heartburn and also gastroesophageal reflux disease.
Obesity, commonly observed in people with type 2 diabetes, is a known cause of gastroesophageal reflux disease. Another reason is the damage caused by diabetes to the nerves that empty the stomach.
To test for acid reflux, your doctor will prescribe an endoscopy, a procedure during which a flexible scope with a camera attached on one end is used to take a closer look at the stomach and esophagus. This flexible scope is known as an endoscope. A pH test may also be prescribed to check the acid levels.
To relieve the symptoms of GERD and heartburn, it is important to keep your blood sugar levels under control and take medications such as proton pump inhibitors or antacids.(10,11)
Gastroparesis occurs when the stomach empties the food too slowly into the intestines.(12) This delayed emptying of the stomach can cause symptoms like:
It is estimated that about one-third of people with type 2 diabetes suffer from gastroparesis.(6) This condition is caused by damage to the nerves that are responsible for contracting the stomach to push food into the intestines.
To determine if you have diabetes gastroparesis, your doctor will prescribe an upper endoscopy or an upper gastrointestinal series. In this, a thin scope with a camera and light attached at the end will provide a complete view of the inside of y our stomach, esophagus, and the first part of the intestines. The doctor will look for blockages or any other issues in the gastrointestinal tract.
Another test, known as gastric scintigraphy, will be done to confirm the diagnosis. This is performed after you eat some food. An imaging scan will then indicate how the food is moving through the entire gastrointestinal tract.(13,14)
It is essential to find out if you have gastroparesis because, without treatment, this condition can make it challenging to manage your diabetes.
Your doctor is likely to recommend that you eat smaller, low-fat meals multiple times during the day instead of having three big meals a day.
You will also need to drink plenty of fluids to help the stomach empty out more easily. You should also avoid consuming high-fiber and high-fat foods that can slow down the emptying of your stomach.
There are medications like domperidone (brand name Motilium) and metoclopramide (brand name Reglan) that are prescribed to manage the symptoms of gastroparesis. However, they do come with several side effects and risks. Reglan can cause several unpleasant side effects such as tardive dyskinesia, which is a condition that causes uncontrollable movements of the tongue and face. Motilium, on the other hand, has fewer risks and side effects, but it is still an investigational drug and only available in some countries. Some doctors also prescribe the antibiotic erythromycin for treating gastroparesis.(15,16)
Dysphagia (Trouble Swallowing)
Dysphagia is a condition where you have trouble swallowing, and you may feel like there is food stuck in your throat.(17) Some of the other symptoms of dysphagia include:
Endoscopy is the primary diagnostic test for dysphagia. Another test is manometry, in which a flexible tube is inserted into the throat, and there are pressure sensors attached that measure the activity of the muscles used for swallowing.
In another diagnostic test known as an esophagram or a barium swallow, you swallow a liquid that contains barium. This liquid coats your entire gastrointestinal tract and helps the doctor see any potential problems on an X-ray clearly.
Proton pump inhibitors and other medications that are used for treating gastroesophageal reflux disease are also used to treat dysphagia. You will also be advised to eat smaller meals throughout the day instead of three big meals. To make swallowing easier, you should also cut your food into smaller pieces.
Fatty Liver Disease
Another link between type 2 diabetes and gastrointestinal issues is that diabetes increases the risk of developing nonalcoholic fatty liver disease. This is a condition where fat builds up in the liver, but not due to excessive alcohol use. It is estimated that almost 60 percent of people with type 2 diabetes have nonalcoholic fatty liver disease. Again, obesity is a risk factor for fatty liver disease as well as diabetes.(18)
Your doctor will recommend a liver biopsy, ultrasound, and blood tests for diagnosing fatty liver disease. You will also need to undergo regular blood tests for checking your liver function after being diagnosed.
It is important to note that nonalcoholic fatty liver disease does not cause any symptoms, but it does increase the risk of liver cancer and liver scarring (cirrhosis). This condition is also associated with a higher risk of cardiovascular disease.(19,20)
Intestinal enteropathy is an umbrella term used to refer to any disease of the intestines. It may show up as signs and symptoms like constipation, diarrhea, and fecal incontinence (trouble controlling your bowel movements).
Diabetes and medications like metformin (brand name Glucophage) that treat diabetes are known to cause symptoms of intestinal enteropathy.(21)
Before diagnosing intestinal enteropathy, your doctor will first rule out the other possible causes of your gastrointestinal symptoms, including celiac disease and stomach infections. If your symptoms are being caused by diabetes medication, your doctor may change you to a different drug.
You might need to change your diet as well and start having a diet that is low in fiber and fat. Eating smaller meals every two to three hours may also help alleviate the symptoms.
Anti-diarrheal medications such as Imodium can help you get relief from diarrhea. However, while having diarrhea, it is essential that you keep drinking electrolyte solutions to remain hydrated. On the other hand, laxatives can help relieve constipation.
However, you should never change your treatment regimen without consulting your doctor.
Gastrointestinal issues are often observed in people with type 2 diabetes. They are likely to experience symptoms like acid reflux, constipation, diarrhea, abdominal pain, amongst others. The longer you have diabetes and take medications for managing your condition, the higher is your risk of developing such gastrointestinal issues.
If you find your digestive issues are becoming chronic and affecting the quality of your life, you must consult your doctor. To prevent such problems and other complications of type 2 diabetes, it is necessary that you stick to your diabetes treatment regimen and follow your doctor’s instructions. Good management of your sugar levels will help avoid such complications of diabetes.
If diabetes drugs are causing these symptoms, it is necessary to see your doctor. You should never stop taking your medications without your doctor’s advice.
Creating the right eating plan will also help you manage your diabetes as well as these gastrointestinal symptoms.
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- Chatterjee, S., Khunti, K. and Davies, M.J., 2017. Type 2 diabetes. The Lancet, 389(10085), pp.2239-2251.
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- Maisey, A., 2016. A practical approach to gastrointestinal complications of diabetes. Diabetes Therapy, 7(3), pp.379-386.
- Dyck, P.J., Karnes, J., O’Brien, P.C., Thomas, P.K., Asbury, A.K., Winegrad, A.I. and Porte, D., 1987. Diabetic neuropathy.
- Brown, M.J. and Asbury, A.K., 1984. Diabetic neuropathy. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 15(1), pp.2-12.
- Nishida, T., Tsuji, S., Tsujii, M., Arimitsu, S., Sato, T., Haruna, Y., Miyamoto, T., Kanda, T., Kawano, S. and Hori, M., 2004. Gastroesophageal reflux disease related to diabetes: analysis of 241 cases with type 2 diabetes mellitus. Journal of gastroenterology and hepatology, 19(3), pp.258-265.
- Kase, H., Hattori, Y., Sato, N., Banba, N. and Kasai, K., 2008. Symptoms of gastroesophageal reflux in diabetes patients. diabetes research and clinical practice, 79(2), pp.e6-e7.
- Takebayashi, K. and Inukai, T., 2015. Effect of proton pump inhibitors on glycemic control in patients with diabetes. World journal of diabetes, 6(10), p.1122.
- Moldovan, C., Dumitrascu, D.L., Demian, L., Brisc, C., Vâtcã, L. and Magheru, S., 2005. Gastroparesis in diabetes mellitus: an ultrasonographic study. Romanian journal of gastroenterology, 14(1), pp.19-22.
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- Clark, D.W. and Nowak, T.V., 1994. Diabetic gastroparesis: What to do when gastric emptying is delayed. Postgraduate medicine, 95(5), pp.195-204.
- Lorenz, R., Jorysz, G., Tornieporth, N. and Classen, M., 1993. The gastroenterologist’s approach to dysphagia. Dysphagia, 8(2), pp.79-82.
- Dharmalingam, M. and Yamasandhi, P.G., 2018. Nonalcoholic fatty liver disease and type 2 diabetes mellitus. Indian journal of endocrinology and metabolism, 22(3), p.421.
- Farrell, G.C. and Larter, C.Z., 2006. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology, 43(S1), pp.S99-S112.
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