Diabetes-Related Diarrhea

How are diabetes and diarrhea related?

Diabetes can cause diarrhea, along with several other gastrointestinal (digestive) problems. Diarrhea is a common symptom of diabetes. It’s more common in people who have had diabetes for a long time.

Sometimes, people with diabetes-related diarrhea also experience fecal (bowel) incontinence, especially at night. That’s because nerve damage (neuropathy) due to diabetes affects the anal sphincter. The anal sphincter is the muscle that opens and closes to allow poop to exit your body.

What is diabetes?

Diabetes mellitus is a condition that happens when your body can’t produce or use the hormone insulin. Insulin allows blood sugar (glucose) into your cells so your body can use it as energy. If you have diabetes, your cells don’t respond to insulin as they should. Your cells don’t absorb the glucose, so the sugar builds up in your blood.

There are two types of diabetes: Type 1 and Type 2. Both can have similar symptoms and complications.

What is diarrhea?

Diarrhea is when your poop is not solid, formed stool. Instead, it comes out loose and watery. Healthcare providers consider it diarrhea when it happens at least three times a day.

What is diabetes-related enteropathy?

Diabetes-related enteropathy is a specific type of nerve damage. It affects the digestive system. Many people with diabetes-related enteropathy have diarrhea, constipation and fecal incontinence.

How common is diabetes-related diarrhea?

It is common. About 22% of people with diabetes (around 1 in 5 people) may have frequent diarrhea.

What causes diabetes-related diarrhea?

People with diabetes may experience frequent diarrhea due to:

• Autonomic neuropathy: Over time, people with diabetes may develop neuropathy from high blood sugar levels. Neuropathy can lead to problems with how food and fluids travel through the colon. It also affects how your digestive system functions overall. You may have constipation alternating with diarrhea.
• Problems in the small or large intestine: Fluids may travel through the colon faster. As a result, you may need to have a bowel movement more often and more urgently. The stool may be watery because it doesn’t have a chance to solidify.
• Other gastrointestinal problems: People with diabetes may have other intestinal problems. Conditions such as irritable bowel syndrome cause diarrhea.
• Sweeteners: People with diabetes often consume a lot of artificial sweeteners. These sweeteners can sometimes cause diarrhea.
• Metformin: This diabetes medicine can cause stomach problems, including diarrhea.

Other possible causes of diabetes-related diarrhea:

• Products with sugar alcohols: Consuming high amounts of sugar alcohols can cause stomach cramping and diarrhea. Check product labels to check for added sugar alcohols in low-carb or sugar-free foods, baked goods and sauces.
• Celiac disease: Some people with diabetes may also have celiac disease or gluten intolerance. For them, consuming even a tiny amount of gluten (a protein in wheat and some other grains) can cause diarrhea or other digestive problems.
• Bacteria in the digestive tract: Sometimes, fluids and food move more slowly through the digestive system. Bacteria may grow, contributing to diarrhea.
• Yeast infection in the GI tract: If you have consistently high blood sugar, yeast infections may form in your gastrointestinal tract. These infections can also cause diarrhea. Fortunately, antifungal medication can easily treat infections.
• Exocrine pancreatic insufficiency: With this problem, your pancreas doesn’t produce enough enzymes, which affects digestion. It can cause diarrhea.

How does diabetes-related diarrhea affect me?

You might have ongoing diarrhea. Or you might have diarrhea for a few months, and then it goes away. You might also experience diarrhea alternating with constipation.

How do healthcare providers diagnose diabetes-related diarrhea?

It’s challenging to figure out if diarrhea you experience is due to diabetes or another condition. Your healthcare provider may ask you to keep a journal to keep track of your bowel movements, including frequency and severity.

You may need to work with a gastroenterologist, a specialist in the digestive system.

How is diabetes-related diarrhea treated?

The most important part of treating diabetes-related diarrhea is to control your blood sugar. Controlling blood sugar can prevent nerve damage and improve your symptoms. A nutritionist can help you develop the best meal plan to improve your symptoms. You may need to:

• Eat plenty of fiber, including whole grains. Be sure to monitor carbs’ effect on your blood sugar.
• Drink more water. You lose fluids through diarrhea.
• Change the vegetables (or amount of vegetables) you eat.

Can medications treat diabetes-related diarrhea?

Your healthcare provider may recommend diarrhea treatments. Antidiarrheal medications can help stop episodes of diarrhea. Medicines that help people with or without diabetes include:

• Diphenoxylate and atropine (Lomotil®), available with a prescription.
• Loperamide (Imodium®), available over the counter.
• Fiber supplements, such as Citrucel® or Metamucil®, or high-fiber foods, which can thicken bowel movements.
• Antispasmodic medications, which can decrease the frequency of bowel movements.

If those medications don’t help, your provider may recommend medications targeted to people with diabetes. These medicines help improve the nerve damage that is the primary cause of diabetes-related diarrhea:

• Octreotide acetate injection: Your provider delivers this medication through an injection (shot). It can decrease the frequency of diabetes-related diarrhea.
• Selective serotonin 5-hydroxytryptamine type 3 (HT3) receptor antagonist: Sometimes called setrons, these medicines treat diarrhea. They can also help with extreme nausea and vomiting.
• Antibiotics and/or pancreatic enzymes: This combination may help if the cause of the diarrhea is a bacterial infection or exocrine pancreatic insufficiency.

How can I live best with diabetes-related diarrhea?

Often, people who have diabetes have digestive problems. But you can take steps to keep these problems to a minimum:

• Improve your blood sugar levels by following the diabetes plan you and your provider develop.
• Take medications as necessary.
• Eat whole foods — including whole grains and fiber.
• Drink plenty of water.
• Get regular exercise.
• Quit smoking and using tobacco products.
• Limit alcohol.

See your healthcare provider if you have diabetes and you have:

• Frequent diarrhea.
• Diarrhea alternating with constipation.
• Other uncomfortable abdominal symptoms.

A note from Cleveland Clinic

All too often, diabetes and diarrhea go together. People with diabetes may experience frequent diarrhea — loose, watery stools that happen at least three times a day. You may have fecal incontinence as well, especially at night. Diarrhea can also be due to metformin, a diabetes medication. If you have diarrhea, an upset stomach or constipation, talk to your healthcare provider. Medications and the right diet plan can relieve diarrhea, so you feel your best.