Is there a connection between diabetes and chronic diarrhea?

April

Diabetes mellitus is frequently complicated by the development of digestive disorders, including diarrhea. The most common way in which diabetes can lead to diarrhea is by causing autonomic neuropathy, a dysfunction in the nerves that control many internal organs, including the gut. Autonomic neuropathy typically occurs after diabetes has been present for many years. Abnormally functioning nerves can prompt the intestinal muscles to move food either too quickly or too slowly, leading to failure of normal digestion. Diarrhea often occurs as a result. The therapy for autonomic dysfunction involves careful control of the blood sugar. Other medications that may be useful include clonidine, which helps compensate for the damaged intestinal nerves, and antidiarrheal medications such as atropine and codeine.

Another cause of diarrhea in people with diabetes is celiac disease, also known as sprue. In celiac disease, the intestinal surface erodes, interfering with nutrient digestion and causing diarrhea. It is not known why diabetic patients are more prone to celiac disease. However, both disorders are linked to abnormal immune function.

Diabetics are also more prone to developing a condition known as bacterial overgrowth. This is characterized by an abnormally large number of bacteria in the small intestine and most likely occurs as a result of autonomic neuropathy. The bacteria break down certain substances in the diet, leading to diarrhea. Bacterial overgrowth can be treated effectively with antibiotics.

People with diabetes are also at increased risk for developing chronic inflammation in the pancreas (chronic pancreatitis). This condition involves destruction of pancreatic cells that produce important digestive enzymes. Loss of these enzymes also results in poor food digestion -- and diarrhea. If chronic pancreatitis is diagnosed, oral enzyme replacement may help reduce the diarrhea.

Finally, all diabetics with diarrhea should talk with their doctors about their intake of medications and foods. Many medications can cause diarrhea as a side effect. In addition, many "sugar-free" foods contain sorbitol, a nonabsorbable carbohydrate that can cause diarrhea.