DR. PONDER: Diabetes can cause a number of other issues
Diabetes can affect every inch of the human gut, from the mouth to the rear end. Three out of four persons with diabetes will report significant symptoms of the intestinal tract over their lifetime. Common complaints include swallowing difficulties, feeling full too early, reflux (heartburn), constipation, abdominal pain, nausea, vomiting and diarrhea. Getting a proper diagnosis takes longer if you or the doctor are not talking about these problems at routine follow up visits. Plus many of the signs and symptoms listed above are present in non-diabetics as well and may not be thought at first to be diabetes related.
If you have other diabetes complications, such as kidney, eye or nerve disease, then it is safe to assume you also have intestinal complications until proven otherwise. Intestinal nerves are damaged by high blood sugars over time, and this is the primary cause for most diabetic GI problems. The following are some of the more common medical conditions a person with diabetes might develop with the intestinal tract.
The liver collects large amounts of fat in obese people. This fatty buildup is called steatosis and is found in 75 percent of type 2 diabetics. Fat in the liver irritates the surrounding normal tissue and increases the risk for diabetes to occur sooner. In my practice, more than 20 percent of overweight children already have evidence of fatty liver before they reach adolescence. There are simple blood tests that can screen for this. Fatty liver can even progress to liver failure in some people. The best treatment is a low fat, low calorie meal plan and weight loss. Daily vitamin E supplements have been shown to be helpful too.
Gallbladder disease is common in obese people and those with diabetes. It used to be a problem found just in overweight, middle aged adults, but now it is much more common in younger people down into the teen years. We have seen a spike in gallbladder surgery in adolescents at our hospital over the past decade that coincides with the child and teen obesity epidemic. Symptoms of gallbladder disease include right-sided abdominal pain, sometimes radiating to the right shoulder, jaundice or pancreatitis. Pancreatitis is a severe and life-threatening condition that is more common in diabetics. It has recently gotten more attention since some diabetes medications were thought to be associated with a higher risk of developing this condition. One common finding is high levels of fats called triglycerides in the bloodstream. Poorly controlled diabetics tend to have high triglycerides, which comes from our diet and from poor blood sugar control. While there are medicines that lower triglycerides, the best treatment is better meal planning and amount, plus exercise and weight loss resulting in better diabetes control. In longstanding diabetes, a condition called gastroparesis can occur. This is the result of damage to the intestinal nervous system that is responsible for keeping things moving smoothly through our gut. In gastroparesis, the stomach fails to empty itself properly after eating. Symptoms include early fullness, bloating, belly pain, nausea or vomiting. Fatty foods and high fiber foods may aggravate this. This can wreak havoc with diabetes control, not to mention the physical symptoms of bloating and nausea. Special medicines and different foods and liquids are used to manage the problem. If you take insulin, it’s important to manage your insulin delivery differently since food will be turned into sugar more slowly in a person with gastroparesis since it gets held longer in the stomach before it moves into the gut, where digestion of carbohydrates into sugar really occurs. Next week I’ll discuss some other serious intestinal problems that every diabetic should know about.
Dr. Stephen Ponder has had type 1 diabetes since 1966. He has been a pediatric endocrinologist for 24 years. Contact him at swponder@gmail.com, or follow him at twitter.com/dr_steve_ponder.
