June 17


How Does Diabetes Affect the Gastrointestinal Tract

By Gabriela

June 17, 2021

GI disorders i.e. gastrointestinal disorders are common in all individuals and including those with diabetes. The chances are extremely high that an individual will develop a problem with the GI tract.

Problems like food poisoning, peptic ulcer disease, irritable bowel syndrome, or gallstones. Around 75 percent of diabetes patients report GI symptoms. Diabetes may affect the entire GI tract such as the esophagus, oral cavity, anorectal region, and large bowel.

Common symptoms and complaints are diarrhea, dysphagia, vomiting, early satiety, nausea, constipation, and abdominal pain. Like other diabetes complications, there may be more serious GI problems. Usually because of poor glycemic control and the duration of the disorder itself.

Most GI complications of diabetes link to the neurons and their dysfunction to supply the enteric nervous system. What can lead to enteric neuropathy is the involvement of the intestinal nerves.

This type of neuropathy can cause abnormalities in absorption, intestinal motility, secretion, and sensation.

The Esophagus and Stomach in Diabetes


This is a condition where there is a delay in emptying food from the stomach which causes retention of the contents of the stomach. This can lead to vomiting, bloating, nausea, early satiety, abdominal pain, and distention.

Very fibrous foods and fatty foods usually exit the stomach very slowly, and that can be poor toleration.

Gastroparesis is based only on the symptoms. The best test for confirmation is the medicine gastric emptying test.

There are several treatments to manage diabetic gastroparesis. In order to relieve your symptoms, you may consume small meals more frequently.

Avoid foods that are high in fat and fiber. And you need to drink plenty of water. To improve gastric emptying, you need to quit smoking, be more active on a daily basis, avoid food high in fiber and fat, and consume smaller meals. It is vital to control your blood sugar.

Ulcer Disease

Ulcer disease is a common condition that affects around 10% of the population. Esophagus i.e. acid irritation of the stomach causes dyspepsia, heartburn, burning sensation, and indigestion.

The usual treatment is with antisecretory medications that are proton pump inhibitors and H2 receptor antagonists. If there is a presence of H. pylori, there is a need for an antibiotic regimen.

There are worse symptoms in patients that have gastroesophageal reflux. In order to control their symptoms, they need therapy with proton pump inhibitors.

Candida Infections

Patients that have diabetes and have poor control over the glycemic index might develop yeast infections in the GI tract. In the case of a mouth yeast infection, there is burning and pain along the throat, and on the tongue, there is a thick white coating.

You can diagnose oral candida with a simple physical examination, but to diagnose candida esophagitis, you will need an endoscopy. You can treat it with antifungal drugs like fluconazole i.e. Diflucan, Nystatin i.e. Mycostatin, and ketoconazole i.e. Nizoral.

The Small Intestine in Diabetes

There are cases of longstanding diabetes that which the enteric nerves that supply the small intestine might be affected, and that can cause abnormal absorption, motility, and secretion.

The symptoms are diarrhea, central abdominal pain, and bloating. Delay in emptying fluids and also stagnation of fluids in the small intestine can cause syndromes of bacterial overgrowth and lead to abdominal pain and diarrhea.

To accelerate the fluids through the small intestine that can happen with cisapride and Metclopropamide, and antibioticstore.online may help lower the bacterial levels. The effective means to treat and diagnose this condition is an empiric trial of antibiotics.

Many antibiotic regimens have been shown to be efficient, this includes courses that last from 5 to 10 days of tetracycline, amoxicillin, and ciprofloxacin. There can be prolonged relief with the short course, but additional courses are necessary when the symptoms recur in several months or weeks.

Individuals that have diabetes can have an increased risk of celiac sprue. In terms of this condition, there is a development of allergy to wheat gluten which leads to thinning and inflammation of the mucosa of the small intestine. It is still not clear why this occurs.

But, sprue may cause malabsorption of food, diarrhea, and weight loss. The condition responds well to a diet that is gluten-free, but the patients usually have difficulties adjusting to that type of diet.

The Colon in Diabetes

There is limited information available in terms of the effects diabetes has on the large intestine. Enteric neuropathy, in fact, may affect nerves that stimulate the colon which in turn may lead to a decrease in colon constipation and motility.

Supplementation with fiber such as psyllium or bran products and a diet that is high in fiber actually contributes to increasing the content of water in the bowel movement.

And that may help relieve constipation. Stool softeners and mild laxatives also may help.

Diabetic Diarrhea

Patients that have a long history of diabetes may have frequent diarrhea, and this occurs in around 22 percent of patients.

This links to problems in the colon or small bowel. There might be an abnormal fast transit of fluids in the colon which can lead to increased stool urgency and frequency.

Furthermore, what you may develop is abnormalities in the secretion and absorption of the colonic fluid. Contributing to increased stool frequency, water content, and volume.

Treating diarrhea is the same for patients without or with diabetes. If there is a nondiagnostic evaluation of diarrhea then as a treatment there is symptomatic care with the use of antidiarrheal agents such as loperamide i.e. Immodium or diphenoxylate i.e. Lomotil.

To decrease watery diarrhea and also thicken the consistency of bowel movements there is a need for fiber supplementation such as foods high in fiber, Metamucil, bran, and Citrucel. In serious cases, there is a need for injections.

The Pancreas in Diabetes

In around 80 percent of people with type 1 diabetes, there is pancreatic exocrine dysfunction. But it is not that significant to cause clinical problems in terms of digestion, which rarely happens.

In fact, the pancreas has a big reserve and in the case of a modest reduction in pancreatic enzyme secretion rarely there is a case that causes difficulty in absorption and digestion of protein, carbs, and fat.

The exocrine pancreas can be affected, but only to a lesser extent with people that have type 2 diabetes. Usually, people with secondary diabetes due to surgical removal of the pancreas or severe pancreatitis have more serious symptoms of insufficiency of pancreatic exocrine.

What is usually effective is treatment with the replacement of pancreatic enzymes.

The Liver in Diabetes

The test for the function of the liver comes up abnormal in people with diabetes. It is not known whether this happens because of poor control of diabetes or because of obesity which is common for people that have type 2 diabetes.

Nonalcoholic steatohepatitis i.e. fatty infiltration is very common in individuals that are obese that including around 90 percent.  And also in people with type 2 diabetes that is around 75 percent.

This symptom might develop in people that have type 1 diabetes. However, this is not that common. The therapy is usually a restricted diet that is low in fat and low in calories. And also improvement of glycemic control.

When there is a restriction of calories that will contribute to the improvement of fatty infiltration, weight loss, lower cholesterol and serum triglycerides, and better glycemic control.

Individuals with diabetes tend to have an increased incidence of gall bladder problems and also gallstones. However, these problems such as fatty infiltration mainly link to obesity-related to type 2 diabetes.

Before, people with diabetes were said to undergo surgery in case of asymptotic gallstones. Because there was a concern that they have a larger risk of complications like rupture of the gall bladder, pancreatitis, and infection.

But that is not like that anymore. Therefore, individuals that have gallstones and diabetes should be treated the same as non-diabetic individuals.

In general, there is a recommendation for surgery just for those patients that have symptoms of gallstones.

Conclusion About Gastrointestinal Track When Combined With Diabetes

Although the GI problems in diabetes are actually common, in clinical practice they are not commonly recognized. Major determinants in terms of the severity and incidence of GI issues are the degree of glycemic control and the duration of diabetes.

There can be an effect on the entire GI tract including the pancreas, mouth, liver, small intestine, esophagus, liver, stomach, and colon. You need to start the workup with GI testing, a thorough history of the patient, radiographic, and a suitable laboratory.

A crucial role in the management of the GI disorder in people that have diabetes plays dietary manipulation, pharmacological therapy, and glycemic control.

Source Everyday Health | NCBI


  • Gabriela

    Co-Founder & Editor-in-Chief of Diabetes Health Page, Fitness trainer and instructor has dedicated her career to educating and informing people for over 10 years. As one of the most passionate diabetes advocates, Gabi has worked tirelessly to ensure that those people receive the education and support they need to properly manage their diabetes and achieve their health, fitness and weight loss goals.

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