Diabetic Diarrhea: Symptoms, Causes, and Treatment Tips

Diabetic diarrhea is one of the gastrointestinal symptoms of diabetes mellitus, and it's common, especially among women with diabetes. Although the treatment can vary based on the cause of diarrhea, maintaining glycemic control is always part of the treatment. This article will explore the causes, symptoms, treatment, and prevention of diabetic diarrhea.

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What Are The Causes of Diabetic Diarrhea?

The diagnosis of diabetic diarrhea can be challenging because diagnosis is made by eliminating causes other than diabetes. Diarrhea can be caused by many things, including:

• Small Intestinal Bowel Overgrowth (SIBO)<p style="margin: 0;">SIBO is an overgrowth of certain bacteria (the ones not typically found) in the small intestine. These bacteria fermentate substances that draw water and cause diarrhea. Diabetes patients are at increased risk of SIBO due to changes in gastric emptying and gut motility¹<p>

• Nerve Damage (Neuropathy)<p style="margin: 0;"> The intestinal system has cells communicating with messenger molecules (neurotransmitters) from nerves. In diabetic autonomic neuropathy, these cells get damaged because of inflammation and oxidative stress caused by diabetes²<p>

Impaired communication between nerves and intestinal cells affects motility and absorption, resulting in gastrointestinal symptoms. High blood sugar levels exacerbate neuropathic symptoms. Therefore, fluctuations in blood sugar can further damage nerves and worsen gastrointestinal issues.

• Diabetes Medication<p style="margin: 0;"> It has been reported that 62% of diabetes patients using metformin experience diarrhea. Some diabetes medications, including Miglitol and acarbose, prevent starch digestion, which attracts water in the intestinal lumen, causing flatulence and diarrhea²<p>

• Celiac Disease<p style="margin: 0;"> Celiac disease and type 1 diabetes are both autoimmune diseases caused by the immune system mistakenly targeting and damaging the body's own tissues. Five percent of type 1 diabetes patients have celiac disease; therefore, a genetic relationship between the two diseases has been hypothesized³<p>

Healthcare providers often recommend screening individuals with type 1 diabetes for celiac disease. Early detection and management of celiac disease through a gluten-free diet are essential to prevent complications and improve overall health in diabetes patients.

• Microscopic Colitis<p style="margin: 0;"> Microscopic colitis is a type of inflammatory bowel disease characterized by inflammation of colon cells. It can cause chronic, watery, and nocturnal diarrhea⁴<p>

• Diet <p style="margin: 0;"> Sugar-free sweeteners such as mannitol and sorbitol can cause watery diarrhea. Sweeteners are not digested well and can cause gastrointestinal symptoms such as bloating, cramps, diarrhea, and so on <p>

Diabetes patients with food intolerances, allergies, or food-related diseases are likely to experience diarrhea. 

Excessive alcohol consumption can also be the cause of diarrhea. Luckily, diet-related causes are easier to correct once the differential diagnosis is made.  

• Exocrine Pancreatic Insufficiency (EPI)<p style="margin: 0;"> The Pancreas produces digestive enzymes to release intestines for digestion of foods. In EPI, the pancreas either can't make enough enzymes, or there is a problem with the delivery and function of enzymes. When enzymes don't digest foods, they cause cramps, bloating, flatulence, and diarrhea⁵<p>

• Diabetic Enteropathy<p style="margin: 0;"> Enteropathy, also known as large bowel dysfunction, refers to digestive problems such as diarrhea, constipation, fecal incontinence, and so on. Diabetic enteropathy is generally caused by damage to the autonomic nervous system and intestine communication⁶<p>

How to Treat Diarrhea?

Treatment options for diabetic diarrhea can change based on the cause of the diarrhea. In any case, the treatment involves hydration and interventions to improve glycemic control. 

• Prevention of Dehydration<p style="margin: 0;">At first, lost fluid and electrolytes are replaced. Different hydration strategies, such as juices, oral rehydration solution (ORS), and IV fluid rehydration, can be used at various stages of dehydration⁷<p>

ORS solutions containing electrolytes can be beneficial in managing mild to moderate dehydration. These solutions help replenish lost fluids and electrolytes and can be particularly helpful during illness or periods of increased fluid loss.

In severe cases of dehydration, intravenous (IV) fluid rehydration may be necessary. This should be administered under medical supervision.

• Antidiarrheal Medications<p style="margin: 0;">Healthcare providers can give medications such as Lomotil (prescription) and Imodium (over-the-counter) to stop diarrhea. However, the use of these medications can be limited in patients with antibiotic-associated ulcerative colitis²<p>

• Antispasmodic Medicine<p style="margin: 0;"> Antispasmodic medication is also given to reduce the frequency of bowel movements⁸<p>

• Bile Acid-Binding Resins <p style="margin: 0;"> Bile acid-binding resins, such as cholestyramine, colestipol, and colesevelam, can decrease the concentration of bile acids in the intestinal lumen. Reduced bile acid concentration results in decreased colonic transit time and permeability of intestinal mucosa, which can improve diarrhea <p>

• Antibiotic<p style="margin: 0;"> In case of bacterial overgrowth or bacterial infection, antibiotics can be given to treat diarrhea <p>

• Probiotics<p style="margin: 0;"> Probiotics can be given to support healthy gut microbiomes with or after the treatment. Some strain-specific probiotics can be prescribed for diseases such as inflammatory bowel diseases<p> 

Probiotics are available in various strains, and different strains may have distinct effects on the body. For specific health issues, consult with a healthcare provider to determine which strain-specific probiotics may be beneficial.

• Dietary Changes<p style="margin: 0;">Artificial sweeteners are commonly used by diabetes patients as a substitute for sugar. However, artificial sweeteners have been shown to cause diarrhea. Avoiding artificial sweeteners may help with diarrhea<p>

While diarrhea is present, low-fiber food, including bananas, applesauce, and toast, firm stool. After the treatment, eating enough fiber can support a healthy blood glucose level and digestive system.

Patients with food intolerances, allergies, or food-related diseases such as celiac disease must avoid the foods causing the problems. 

<p class="pro-tip"><strong>Learn More: </strong><a href="bad-breath-from-stomach">Stomach Problems and Bad Breath: What's the Connection?</a>.</p>

Indicators for Seeking Medical Advice

Diarrhea may not resolve on its own. If you have diarrhea for more than two days and it hasn't improved, bloody diarrhea, dehydration, fever, weight loss, or pain preventing eating, you should see a doctor.⁹

• Dehydration Occurring <p style="margin: 0;">If you're feeling too thirsty and weak and experiencing no or little urination, dark-colored urine, or dry mouth, you're dehydrated. If you can't replace lost fluids and electrolytes at home, you should see a doctor for medical rehydration treatments<p>

• Development of Any Type 2 Diabetes Symptoms<p style="margin: 0;"> If you're experiencing any diabetes symptoms such as losing weight without effort, feeling excessive thirst, tingling or numb hands or feet, or fatigue, consult your healthcare provider to get proper treatment before developing any complications¹⁰ <p>

• Poor Glucose (Blood Sugar) Control<p style="margin: 0;"> Being sick with diabetes can be challenging. In sickness, people generally have no appetite and do not eat for a long time, which can be dangerous for diabetes patients¹¹<p>

It can be harder to maintain target blood glucose when diarrhea is due to lost fluids, electrolytes, and insufficient food. You can track your blood glucose levels, and if your blood glucose is lower than 60 mg/dl, go to an emergency room.¹¹

• Worsening Diarrhea Persisting for More Than Two Days<p style="margin: 0;">If you have diarrhea for more than two days and it hasn't improved, you should see a doctor<p>

• Nausea and Vomiting<p style="margin: 0;">If you're losing water and electrolytes through vomiting or severe diarrhea for more than six hours, the Centers for Disease Control and Prevention (CDC) recommends visiting the emergency room¹¹<p>

• Severe Abdominal or Rectal Pain<p style="margin: 0;"> Abdominal and rectal pain can stem from diabetes enteropathy. You should consult a doctor for pain relief and treatment¹²<p>

• Potential Nutritional Deficiencies<p style="margin: 0;"> Some types of diarrhea are caused by insufficient nutrient absorption, which can lead to nutritional deficiencies and weight loss. If you're seeing oily stool and losing weight, consult your healthcare provider<p> 

Also, episodes of diarrhea and constipation can be seen in diabetes patients, especially those who also have inflammatory bowel diseases. 

Gastrointestinal problems can disturb patients' eating, resulting in poor nutrition. Consulting a doctor can help patients identify and close the nutritional gaps through nutrition planning and, if needed, supplementation. 

• A Greater Risk of Complications<p style="margin: 0;"> If you're a patient with a history of certain complications of diabetes, you should be more careful about sickness. For example, If you're a diabetes patient with a history of cardiovascular events such as heart attack, you're more susceptible to developing the same complication. When experiencing diarrhea and if your blood sugar levels are fluctuating and out of target numbers, consult your healthcare provider¹³<p>

Tips for Preventing Diarrhea

As discussed above, there could be many causes of diarrhea. Maintaining healthy blood sugar levels is one of the goals of treating all diabetes diarrhea; resolving real reasons can carve the pathway for prevention.

• Maintain Blood Sugars Within a Target Range<p style="margin: 0;"> Uncontrolled blood glucose levels worsen diabetes-related pathologies that trigger diarrhea and other symptoms of the gastrointestinal tract. Therefore, glycemic control is one of the main goals of diabetes diarrhea treatment<p>

• Stabilize Blood Sugar to Reduce Neuropathy Risk<p style="margin: 0;"> Unstabilized blood glucose can cause nerve damage in the long term. When communication between neurons and cells of the digestive system is damaged because of neuropathy, gastrointestinal symptoms occur. Maintaining target blood glucose levels can prevent neuropathy and neuropathy-related diarrhea<p> 

• Adjust Diet to Avoid Triggering Foods<p style="margin: 0;"> Food intolerances can cause diarrhea. Spotting and eliminating triggering foods under a dietitian's and doctor's supervision can prevent diarrhea <p>

• Screen for Celiac Disease if You Have Type 1 Diabetes<p style="margin: 0;"> Research showed that type 1 diabetes patients have an increased likelihood of having celiac disease. If celiac disease presents itself, a gluten-free diet can prevent diarrhea<p>

• Don’t Forget the Importance of Hygiene <p style="margin: 0;">Proper handwashing is one of the most effective ways to prevent infection-related diarrhea. Wash your hands with soap and clean water for at least 20 seconds, especially before eating, after using the restroom, and after handling raw food <p>

• Fiber-Rich Diet <p style="margin: 0;">Consume a balanced diet that includes high-fiber foods like fruits, vegetables, and whole grains. Fiber can help regulate bowel movements and reduce the risk of diarrhea<p>

Learn How to Improve Your Nutrition and Monitor Your Glycemic Index Levels with Signos' Expert Advice.

Signos' CGM, a continuous glucose monitoring system, offers continuous blood glucose data that can be leveraged for better glucose management. The system measures your glucose levels in real-time and sends the data to your phone, where you can see the changes in your blood glucose over time. 

Signos can improve your health by providing blood glucose levels throughout the day. Therefore, you can understand how your nutrition, exercise, medication, and other actions affect your blood glucose levels. The system also provides personalized recommendations for nutrition and training in addition to sleep, hydration, nutrition, and exercise tracking. 

If you're curious about how Signos' CGM helps you, take a quick quiz and explore.

<p class="pro-tip"><strong>Also Read: </strong><a href="/blog/how-to-relieve-stomach-pain-from-overeating">Find Yourself Overeating? Here's How To Relieve Stomach Pain</a>.</p>