The common and not-so-common gastrointestinal issues that people with Diabetes are more prone to experiencing.

When it comes to diabetes-related complications and diseases most of us are familiar with the “-opathies” – Nephropathy, retinopathy, and neuropathy (If you’re not familiar with these reach out to our office for an appointment – we can help educate and empower you toward better health with diabetes.)

But did you know that the gut is an area that diabetes impacts a lot more than we realize?

We have known for a long time that a leading complication of diabetes (both types 1, 2, and everything between and around those) is gastroparesis.

Gastroparesis is a form of neuropathy that impacts digestive tract motility.
– You can check out some of our gastroparesis-related articles IDS has written over the years.

We have also known that people with type 1 diabetes are 6x more likely to develop celiac disease than the general population.

– Read an article on celiac and gluten intolerance.

gastrointestinal issues and diabetes

More and more these days we are seeing research and medications addressing the fact that diabetes is not only a disease about problems with insulin function and use, but one of pancreatic dysfunction. And the pancreas makes a lot more than just insulin and glucagon.

It is responsible for the production of a host of hormones and enzymes that relate to digestion:

  • Gastrin: stimulates digestion
  • Amylin: regulates stomach emptying and satiety signals

For info on pancreatic hormones and their diabetes connections check out these amylin-related articles

  • Lipase: fat digestion
  • Amylase: Carb digestion
  • Trypsin and Chymotrypsin/ Proteases: Protein digestion
  • Elastase: fat, carb and protein digestion

When these enzymes are not produced and released properly it leads to a disease called exocrine pancreatic insufficiency (EPI). We have known that one of the main impacts of cystic fibrosis is EPI as there is damage to the pancreatic duct that inhibits the release and production of enzymes. Likewise, chronic pancreatitis is another common cause of EPI, If your brain works like mine you’re thinking, well those diseases cause damage to the pancreas and so lead to EPI, but doesn’t diabetes also cause damage to the pancreas? The answer if YES! And yet there has been very little research into correlations between diabetes (of all types) and EPI.

But in a study recently released recently in Diabetes Technology and Therapeutics data research shows a median prevalence of 33% of people with type 1 diabetes and 29% of people with Type 2 diabetes meet diagnostic criteria for EPI, but most were not diagnosed! This means that EPI could be one of the most common complications of diabetes! It also is a complication that is independent of glucose control. This means that having good glycemic management may not reduce your risk for GI complications of diabetes.

What are the symptoms of EPI?

  • Bloating
  • Changes in stool (fatty stools, increased frequency or urgency of bowel movements)
  • abdominal pain,
  • Gas
  • Weight loss
  • erratic post-meal blood sugars
  • Weight loss/ signs of malnutrition or nutrient deficiency.

How can I find out if I have EPI?

Growing awareness of the prevalence of EPI in people with diabetes is leading to expanding recommendations for screening for EPI. Screening is recommended for anyone with diabetes or prediabetes showing GI symptoms. It can be diagnosed most easily with a Fecal elastase test (FE-1) which checks a stool sample for the presence of a pancreatic digestive enzyme following a meal containing protein. (There are other, more arduous, or invasive tests possible for complex cases or people with more severe symptoms) You can talk with your endocrinologist or PCP about testing. Following up with a GI specialist is recommended for follow up.

How is EPI treated?

EPI is commonly treated by taking a digestive enzyme tablet before meals (sometimes only before problematic meals like those high in protein, carb or fat, but dosing is simple and very low risk so dosing before all meals is typically recommended).  Pancreatic enzyme replacement therapy (PERT) is a very low-risk medication, side effects are rare and are largely no different form the symptoms of EPI itself. Most insurances have a low-cost PERT option on their formulary, though specific brand name medications can be very high in cost.

Are there diabetes benefits to PERT therapy?

Yes! Many patients, even those who have gastric complaints but subclinical EPI find that their blood sugars are more stable and easier to manage on enzyme treatment. Some patients who have problems with GERD, or who have even been diagnosed with gastroparesis even see marked improvement in their symptoms with the addition of PERT to their treatment regimen.

As a nurse here at IDS my favorite part of my job is helping clients not only manage their blood sugar, but manage their overall wellness. Working with patients through GI issues, or other chronic issues that arise to help them achieve not only diabetes management skills, but a better quality of life and health in all areas of their medical world is so enriching. If you are facing medical challenges and have type 1 diabetes, I would urge you to give us a call for a consultation. When your other health issues are managed well it’s easier to take care of your diabetes and live a fuller life too.