Information on: Diabetic Gastroparesis and more

Read more about diabetic: esophagus / stomach / bowels

The Diabetic Bowels: Issues and Challenges, Constipation/Diarrhea.

Constipation: Introduction / Diagnosis / Treatments / Surgery / Pelvic floor & bio-feedback

Diarrhea: Introduction, Small bowel Bacterial Overgrowth / Treatments for diarrhea / General Bowel Tips

Diarrhea in diabetes, Introduction and more:
The passage of loose and frequent stools with a sense of urgency is not uncommon with diabetics. Little research has been done in this area.

Chronic diarrhea does occur in the general population and needs investigation when it interferes with daily routines. Investigations into causes of diarrhea are similar to those covered above under constipation.

Causes of diarrhea in diabetics are thought to be related to:

• Celiac disease (wheat or gluten intolerance)

• Small bowel bacterial overgrowth
• Ano-rectal disorders
• Inadequate breakdown of sugars (fructose, lactose and sorbitol) in the small intestine
• Constipation can be a cause of diarrhea: more liquid stool may escape around a hard stool impaction.

• Pancreatic insufficiency

Problems of altered motility related to a malfunctioning gut nervous system as well as to excessive gut secretions brought on by diabetes are also thought to play a role in diabetic diarrhea.

Celiac disease is a genetic inability to digest specific proteins found in grains. Poor digestion of the protein, or gluten, often causes problems of chronic diarrhea, weight loss and fatigue. Celiac disease is found in association with Type 1 diabetes. A simple blood test screens for celiac disease in Type 1 diabetics who have a history of diarrhea. A small bowel tissue biopsy taken during an endoscopic procedure of the upper gut is often used to confirm the diagnosis of celiac disease.

A word about sorbitol and naturally occurring sugars
Many people may have a hereditary difficulty in digesting some very common sugars such as lactose (natural sugar found in milk) and fructose (natural sugar found in fruits). For those people who are lactose- or fructose-sensitive, consumption of these sugars quickly produces symptoms of bloating, belching, abdominal cramps and diarrhea.

Whether diabetics have more trouble than others in digesting sugars is not known for sure, but sorbitol, a sweetener commonly found in diabetic foods, has proven to be a potent laxative - even in amounts as small as 10 grams.

What is sorbitol?
Sorbitol is a sweetening agent frequently added to commercial diabetic and calorie-reduced food products. It has a little over half the amount of calories compared to regular table sugar (sucrose) and is not easily absorbed by the gut. Sorbitol is a naturally occurring sugar, but is commercially formulated through the hydrogenation of glucose (an example of glucose is honey). It is found in dietetic syrups, cake mixes and a wide variety of candies. Many individual packages of these candies or flavoured drinks (sodas) contain more than 10 grams of sorbitol. This food additive - even in small amounts - may produce profuse, watery diarrhea and abdominal pain, cramping and bloating.

Many of the problems of digesting sugars such as fructose, lactose and sorbitol are related to the amount that is consumed and the individual's sensitivity. Therefore, one should simply experiment and find what level can be tolerated. Cutting back on how much you eat or drink of these items allows you to still enjoy these foods while controlling symptoms.

Diarrhea alert: Sorbitol, a common sweetener found in calorie-reduced and commercial diabetic foods may cause profuse, watery diarrhea.

Nocturnal diarrhea/stool incontinence
A small number of diabetics - often Type 1 diabetics - may suffer from the embarrassing and troublesome problem of nocturnal fecal incontinence.

A normally functioning colon is quiet, or non-active, during sleep. Loss of bowel function at night and the involuntary release of stool (incontinence) are usually related to long-standing diabetes and generally reflect damage to a branch of the autonomic nerves that help to inhibit bowel activity during sleep. Furthermore, a weakened anal sphincter muscle (also caused by nerve damage) adds to the problem.

Small bowel bacterial overgrowth (SBBO)
Abnormal motility in the diabetic colon, as discussed above, frequently occurs with sluggish motility in the mid-gut or small intestine. Slow motility places individuals at a much higher risk for small bowel bacterial overgrowth.

Symptoms of SBBO are very similar to the symptoms mentioned for poor sugar digestion: boating, belching, rumbling gut, and diarrhea or alternating constipation. Some studies have suggested that nearly half of the problems of diabetic diarrhea are related to SBBO. Furthermore, untreated SBBO will create problems of poor sugar digestion, weight loss and nutrient depletion.

It is a significant problem, but easy to treat with antibiotics. To learn more, please see our patient educational booklet on SBBO.

Pancreatic insufficiency
Recall the pancreas has two functions: First, for the regulation of blood glucose levels and second, for producing digestive enzymes which are excreted into the small bowel. In individuals with type I diabetes, pancreatic digestive enzymes may also be deficient. Reduced pancreatic digestive enzymes can create problems of fatty stools (steatorrhea) and diarrhea, along with symptoms very similar to gastroparesis: nausea, fullness, bloating and abdominal pain. In fact, gastroparesis and pancreatic dysfunction may occur together. Supplementing at each meal with pancreatic enzymes may help relieve symptoms of diarrhea.

Return to top