The Gastrointestinal Tract and Diabetes

     Gastrointestinal tract problems such as ulcers, irritable bowel syndrome, gallstones, food poisoning and other maladies are common in about everyone.  If you have diabetes, the problems mentioned above plus many other problems are extremely high.  Let's discuss some of the problems diabetics are likely to have or problems made worse from having the disease.

     Close to 80% of diabetics will report some GI symptoms to their doctors.  The entire digestive tract can be affected by diabetes from your mouth to the rectum region.  The more common complaints are dysphagia (problems that cause an inability to swallow or difficulty in swallowing), early satiety ( a sense of being full with food), reflux (a return or backward flow), constipation, nausea, vomiting, diarrhea and/or some type of abdominal pain.   

     Many GI complications seem to be related to dysfunction of the neurons supplying the small intestine nervous system leading to a type of neuropathy.  This is a type of “involuntary” neuropathy that can lead to abnormalities in intestinal motility (to move spontaneously), sensation, secretion, and absorption.  Nerve fibers can either stimulate or inhibit intestinal motility and function.  Damage to these nerves can lead to a slowing or acceleration of intestinal function. 

     Damaged autonomic nerves can cause gastroparesis (gastro indicates the stomach and paresis means running slow or paralysis).  The stomach is a neuromuscular organ that receives food, mixes it with acid and pepsin, than empties it into the small intestines for absorption.  When gastric movement is functioning as it should, the postprandial (after eating) is pleasant.  If your food cannot be broken into small pieces and moved to the intestines normally, it stays in the stomach too long, resulting in pain or discomfort; gastroparesis might be the problem.  Some symptoms are: abdominal bloating, abdominal pain, feeling of being full too quickly after eating, loss of appetite, nausea and vomiting up partially digested food.  Running high blood sugar aggravates gastroparesis, often resulting in hypoglycemia, because food is absorbed at unpredictable times.  If you are on insulin, your doctor may require you take more insulin, eat smaller meals and eat more often.  Cut back on fatty foods and difficult-to-digest foods such as citrus fruits, legumes, and lentils.  Light postprandial exercise such as walking will help.  Your doctor may want you to go on medication.  Good blood sugar control is essential.

     Sometimes, in people who have had diabetes a long time, the nerves supplying the small intestines can be affected leading to abnormal motility, secretion or absorption. Symptoms of damaged enteric nerves include central abdominal pain, diarrhea and bloating. Delayed emptying of these fluids in the small intestines may lead to bacterial overgrowth resulting in diarrhea and abdominal pain. This pain is similar to the pain you have with peripheral neuropathy in the feet. Ask your doctor about gastroparesis if you are having abdominal pain, having a full feeling when you haven’t eaten much, and/or unexplained nausea.

Diabetes can lead to nerve damage in the large intestines. Neuropathy can affect the stimulation of a nerve to the colon leading to a decrease in colon movement causing constipation. Having diabetes can also cause a rapid abnormal transit of fluids in the colon leading to increased stool frequency and urgency. In addition, abnormalities in the absorption and secretion of colonic fluid may develop leading to stool volume, requency and water content.        Ulcer disease is very common.  Acid irritation to the stomach or esophagus can lead to heartburn, indigestion, burning sensations in the upper abdomen, or dyspepsia (trouble swallowing).  Helicobacter pylori are the bacteria responsible for most ulcers and many of the causes of stomach inflammations.  Individuals with ulcers are usually treated in the same way regardless of whether they have diabetes or not but Blood Sugar Control is essential for any healing process.

     Diabetics may develop yeast infections in the GI tract, especially when they do not have good glycemic control.  Yeast infection of the mouth can cause thrush.  If the infection extends further, candida esophagitis can result, which may cause intestinal bleeding, heartburn, and difficulty swallowing.  Candida infection is one of the most common causes of vaginitis in women.  Treatment is highly effective with the eradication of the yeast using antifungal medications prescribed by your doctor.

     GI problems in diabetes are common.  The duration of diabetes and the degree of glycemic control are major determinants in the incidence and severity of GI problems. 
Always check with your doctor before deciding what to do if you are having persistent problems.