The gastrointestinal (GI) system is a fascinating yet super complex bodily system. People with diabetes commonly also have multiple GI symptoms due to consequences of diabetic autonomic neuropathy involving the GI tract. In other words, members with diabetes have abnormal GI motility due to damage to nerves that control involuntary bodily functions. In fact, up to 75% of people with diabetes experience GI symptoms. The most common symptoms seen in diabetic patients are postprandial fullness with nausea, bloating, abdominal pain, diarrhea, and constipation. Apart from individual symptoms experienced, diabetics are also known to present with GI disorders. Three common GI disorders are gastroparesis, nonalcoholic fatty liver disease, and small intestinal bacterial overgrowth.
Gastroparesis is known as delayed gastric emptying in the absence of mechanical obstruction. It occurs as a result of autonomic neuropathy affecting the stomach. During normal digestion, the stomach contracts to help break down food and move it to the small intestine. In gastroparesis however, the stomach doesn't move the broken down food into the small intestine easily. The main symptoms associated with gastroparesis are nausea, vomiting, abdominal pain or discomfort, bloating, early satiety, and postprandial fullness. Optimal treatment includes targeting nutrition, hydrating adequately, and working on glycemic control. All of these help in symptom relief.
Another gastrointestinal disorder is nonalcoholic fatty liver disease (NAFLD). NAFLD is an umbrella term for a few liver diseases such as steatosis, nonalcoholic steatohepatitis, and cirrhosis. NAFLD is when extra fat builds up within liver cells. This is most common in type 2 diabetes, which is when blood glucose (blood sugar) levels are too high. In fact, NAFLD occurs in at least half of the population with type 2 diabetes. It is strongly linked with overweight/ obesity and insulin resistance. Although the liver is being damaged, NAFLD does not usually cause symptoms. However, if symptoms are present, then they include fatigue and pain/ discomfort in the upper right abdomen. Treatment for NAFLD includes lifestyle changes, pharmacological treatment of liver disease, treatment of hyperglycemia (an excess of glucose in the bloodstream), and control of other cardiovascular risk factors associated with NAFLD such as reducing the risk of heart disease.
Furthermore, diabetic patients are at higher risk of developing small intestinal bacterial overgrowth (SIBO) due to slowed motility. SIBO is a condition that develops as a consequence of too much bacteria colonized in the small intestine. This promotes the generation of gases and other byproducts that cause symptoms. The two gases that can be produced are hydrogen or methane. Symptoms include bloating, distention, flatulence, belching, abdominal discomfort, diarrhea, and unintentional weight loss. It is important to note that the symptoms experienced by one individual may not be the same as another individual. This is due to the fact that the microbial flora, or the types of bacteria in our guts, presents differently in every individual. Treatment for SIBO includes taking an oral antibiotic and doing modifications to one's diet.
Although there are many gastrointestinal disorders associated with diabetes, gastroparesis, nonalcoholic fatty liver disorder, and small intestinal bacterial overgrowth are three of the most common disorders in the diabetic community. Gastrointestinal disorders may not be easily seen with the naked eye, but they have a huge impact on an individual's quality of life. Luckily, due to advancements in the medical world, understanding how to treat and manage gastrointestinal disorders has become, and is continuing to become, easier.
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