I am a Diabetic and have IBS

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A review article by

Dr. Somedatta Ghosh (Pal)

Common people mostly identify diabetes by hyperglycemia and insulin deficiency. They pay attention to reduce the number of blood sugar level. But diabetes is actually a chronic metabolic disorder that can affect our multiple organs.

It is found that 75% of DM (diabetes mellitus) patients have symptoms of a variety type of gastrointestinal (GI) complications, like heartburn, non-cardiac chest pain, dysphagia, bloating, diarrhea, constipation, fecal incontinence etc. This group of symptoms together is called irritable bowel syndrome (IBS).

Why DM Cause IBS?

There are multiple factors responsible for DM associated IBS:

• Damage to nervous system: Hyperglycemia increases free reactive oxygen species in the blood, that cause oxidative damage to the veins, arteries and tiny blood vessels. Thus peripheral nerve cells in the GI tract get less oxygen through blood circulation and start to die. Thus the nerves can’t send signal to brain properly and become either hyperactive or inactive.

When it happens to esophagus diabetics suffer from acid-reflux and heart burn.

• Damage to ICC cells: These cells are found in GI tract and have significant contribution in the movement of the bowel thorough out the gut. Their damage can cause constipation.
• Damage to smooth muscles: These muscles in GI help in mixing of the food with enzymes and its movement through GI tract digestion and nutrient collection from it. Their damage slow down bowel movement and easily cause indigestion, heart burn, constipation etc.

Management of IBS for Diabetics

Diabetes patients are normally advised to eat high-fiber-containing food to keep their blood sugar level under control. These fibres help to reduce the symptoms of both diarrhoea and constipation in IBS.

• Beans and vegetables: They are high fiber-containing food. But IBS symptoms include bloating and gas, then the patient should avoid beans.
• Fruits: All types of whole fruits are good for them. But fruit juice is not advised because it does not contain the fiber.
• Dairy Products: Low fat milk and dairy products are good for both DM and IBS. But curd is very good for IBS because it contains good bacteria for digestion.
• Fish and Meat: Usually these are well tolerated in both the problems. Patients can eat in moderate quantities.

But diet for a diabetic patient with diarrhoea should be a little different from a patient with constipation.

• If Patient has Diarrhea: In this case soluble fibers are not good. A patient should avoid soluble fiber containing foods, like: oats, bananas, carrots, apples, barley etc.
• If Patient has Constipation: In this patients need insoluble fibers. Whole grain, wheat bran, cereals, nuts, potatoes etc will be good for them.
• Interval Between Meals: Spread your food intake throughout the day at regular interval. Eating large quantity of foods at very long intervals does not suit for both diabetes and IBS. It spikes the sugar level for diabetes and brings digestion problems for IBS.

Treatment

Mostly IBS in diabetic patients remain under control through lifestyle management. But treatment is needed if IBS symptoms become severe, like rectal bleeding, vomiting, belly pain etc.

CT scan, colonoscopy and endoscopy are done to assess the damage in the colon. A stool test is done to know the presence of bacteria, parasites and bile acid.

What You Can Do at Home

You as a patient very different from others and your disease journey is completely different you might be having diabetes alone or other complications as well. The decision of health has to be based on your profile your problem and suggestions which only suit and apply to you to make you healthy. Most of you take decisions very randomly without knowing anything. That’s why Join INIGIMA now to seamlessly monitor blood sugar, track antibiotic usage, and record physiological changes. Gain personalized insights for effective medication management. Your health journey starts with a simple signup—take charge and thrive with INIGIMA!”

References:

1. Piper MS, Saad RJ. Diabetes Mellitus and the Colon. Curr Treat Options Gastroenterol. 2017 Dec;15(4):460-474.
2. Agashe S, Petak S. Cardiac Autonomic Neuropathy in Diabetes Mellitus. Methodist Debakey Cardiovasc J. 2018 Oct-Dec;14(4):251-256.
3. Al-Shboul OA. The importance of interstitial cells of cajal in the gastrointestinal tract. Saudi J Gastroenterol. 2013 Jan-Feb;19(1):3-15.
4. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/eating-diet-nutrition
5. https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/irritable-bowel-syndrome-ibs/managing-irritable-bowel-syndrome-ibs/