Type 2 diabetes is a disease of high blood sugar. Your body becomes more resistant to the effects of the hormone insulin, which normally moves glucose (sugar) out of your bloodstream and into your cells.
Rising blood sugar damages organs and tissues throughout your body, including those in your GI tract.
Up to 75 percent of people with diabetes have some type of GI issue. Common symptoms include:
Many of these GI issues are caused by nerve damage from high blood sugar (diabetic neuropathy).
When nerves are damaged, the esophagus and stomach can’t contract as well as they should to push food through the GI tract. Some drugs that treat diabetes can also cause GI issues.
Here are some of the GI issues linked to diabetes and how to treat them.
When you eat, food travels down your esophagus into your stomach, where acids break it down. A bundle of muscles at the bottom of your esophagus keeps the acids inside your stomach.
In gastroesophageal reflux disease (GERD), these muscles weaken and allow acid to rise up into your esophagus. Reflux causes the burning pain in your chest known as heartburn.
People with diabetes are more likely to have GERD and heartburn.
Obesity is one cause of GERD that’s more common in people with type 2 diabetes. Another possible cause is diabetes damage to the nerves that help your stomach empty.
Your doctor can test for reflux by ordering an endoscopy. This procedure involves the use of a flexible scope with a camera on one end (endoscope) to examine your esophagus and stomach.
You may also need a pH test to check your acid levels.
Managing your blood sugar levels and taking medications like antacids or proton pump inhibitors (PPIs) can help relieve GERD and heartburn symptoms.
Dysphagia causes you to have trouble swallowing and a feeling like food is stuck in your throat. Its other symptoms are:
- sore throat
- chest pain
Endoscopy is one test for dysphagia.
Another is manometry, a procedure in which a flexible tube is inserted down into your throat and pressure sensors measure the activity of your swallowing muscles.
In a barium swallow (esophagram), you swallow a liquid containing barium. The liquid coats your GI tract and helps your doctor see any problems more clearly on an X-ray.
PPIs and other drugs that treat GERD may also help with dysphagia. Eat small meals instead of big ones and cut your food into small pieces to make swallowing easier.
Gastroparesis is when your stomach empties food too slowly into your intestines. Delayed stomach emptying leads to symptoms like:
- belly pain
About one-third of people with type 2 diabetes have gastroparesis. It’s caused by damage to the nerves that help your stomach contract to push food into your intestines.
To find out whether you have gastroparesis, your doctor can order an upper endoscopy or upper GI series.
A thin scope with a light and camera on the end gives your doctor a view inside your esophagus, stomach, and the first part of your intestine to look for blockages or other problems.
Gastric scintigraphy can confirm the diagnosis. After you eat, an imaging scan shows how the food moves through your GI tract.
It’s important to treat gastroparesis because it can make your diabetes harder to manage.
Your doctor or a dietitian may recommend that you eat small, low-fat meals throughout the day and drink extra fluids to help your stomach empty more easily.
Avoid high-fat and high-fiber foods, which can slow stomach emptying.
Drugs like metoclopramide (Reglan) and domperidone (Motilium) can help with symptoms of gastroparesis. Yet, they come with risks.
Reglan can cause unpleasant side effects like tardive dyskinesia, which refers to uncontrollable movements of the face and tongue, although it’s not common.
Motilium has fewer side effects, but it’s only available in the United States as an investigational drug. The antibiotic erythromycin also treats gastroparesis.
Enteropathy refers to any disease of the intestines. It shows up as symptoms like diarrhea, constipation, and trouble controlling bowel movements (fecal incontinence).
Both diabetes and drugs like metformin (Glucophage) that treat it can cause these symptoms.
Your doctor will first rule out other possible causes of your symptoms, such as an infection or celiac disease. If a diabetes drug is causing your symptoms, your doctor may switch you to a different medication.
A change in diet may also be warranted. Switching to a diet that’s low in fat and fiber, as well as eating smaller meals, may help with symptoms.
Anti-diarrheal drugs like Imodium can help relieve diarrhea. While you have diarrhea, drink electrolyte solutions to avoid getting dehydrated.
Also, laxatives can help treat constipation.
Be sure to talk to your doctor before making any changes to your treatment regimen.
Diabetes increases your risk of developing nonalcoholic fatty liver disease.
This is when fat builds up in your liver, and it’s not due to alcohol use. Nearly 60 percent of people with type 2 diabetes have this condition. Obesity is a common risk factor for both diabetes and fatty liver disease.
Doctors order tests like ultrasound, liver biopsy, and blood tests to diagnose fatty liver disease. You may need to have regular blood tests to check your liver function once you’ve been diagnosed.
Fatty liver disease doesn’t cause symptoms, but it can increase your risk of liver scarring (cirrhosis) and liver cancer. It’s also been linked to a higher risk of heart disease.
Keep your diabetes well managed to help prevent further damage to your liver and reduce your risk of these complications.
Your pancreas is the organ that produces insulin, which is the hormone that helps lower your blood sugar after you eat.
Pancreatitis is inflammation of the pancreas. Its symptoms include:
- pain in the upper belly
- pain after you eat
People who have type 2 diabetes may have an increased risk of pancreatitis compared with people who don’t have diabetes. Severe pancreatitis can cause complications like:
- kidney failure
- breathing problems
Tests used to diagnose pancreatitis include:
- blood tests
- CT scan
Treatment involves fasting for a couple of days to give your pancreas time to heal. You may need to stay in a hospital for treatment.
See a doctor if you have bothersome GI symptoms, such as:
- a feeling of fullness soon after you eat
- belly pain
- trouble swallowing, or feeling like there’s a lump in your throat
- trouble controlling your bowel movements
- weight loss
GI issues are much more common in people with type 2 diabetes than in those without this disease.
Symptoms such as acid reflux, diarrhea, and constipation can negatively affect your life, especially if they continue long term.
To help prevent GI issues and other complications, follow the diabetes treatment plan your doctor prescribes. Good blood sugar management will help you avoid these symptoms.
If your diabetes medication is causing your symptoms, don’t stop taking it on your own. See your doctor for advice on switching to a new medication.
Also, talk to your doctor about creating the right meal plan for your dietary needs or getting a referral to a nutritionist.