Diabetes & Gastro Problems

Diabetes & Gastro Problems

[The 3-D Problems]

Gastro interstitial problems are very common in patients with diabetes. Up to 75% of diabetics experience GI problems significant enough to affect daily life.

The three main types of gastro problems in diabetes can be grouped as 3-D problems.

• Diabetic gastro paresis
• Diabetic colopathy
• Drug-induced gastro adverse effects due to oral anti-diabetic agents

Diabetic Gastro Paresis:

• Diabetic gastro paresis is due to weakness in the nerves supplying the stomach, due to long-term diabetes with resultant slowing of stomach emptying. Patient experiences upper abdomen bloating, early satiety and nausea +/- abdominal discomfort.
• It is a diagnosis of exclusion and hence needs evaluation including upper GI endoscopy to rule out causes of gastric outlet blockage.
• The condition is treated with diet modification and medication (a class called prokinetics is used for valuable durations). Also, the use of specific anti-diuretics drugs such as GLP – 1 Agonists/DPP4 – blockers need to be discontinued and alternative oral anti-diabetic drug considered.

Diabetic Colopathy:

• Diabetic colopathy is a condition in which the nerve supply to the colon is affected due to diabetes and patients present with symptoms of constipation (60% incidence) and diarrhea (20% incidence) +/- fecal incontinence (loss of anal sphincter control with soiling of under garments) – these symptoms can affect the patient so much.
• Diagnosis of the condition needs studies like colon transit study and colonoscopy (to exclude other causes).
• Treatment involves a multi-dimensional approach with due attention to discontinuation of specific anti-diabetic drugs, modification of diet and lifestyle, use of anti-diarrheal agents like loperamide, use of luminal antibiotics like rifaximins, and in severe cases, use of anti-secretory therapy like octreotide analogs.

Drug-Induced Gastro Problems in Diabetes:

• Drug-induced gastro problems in diabetes is due to the use of medications like metformins, gliptins, Acarbose and other newer anti-diabetic agents which can result in GI side effects including constipation, diarrhea, abdominal bloating, nausea and abdominal discomfort. The incidence is in the range of 10-20% implying 80% of patients do not experience such side effects.
• However, this needs to be addressed in every patient with diabetes who presents with new onset GI symptoms. A change to a different mode of diabetic control should be offered to see if symptoms improve with the discontinuation of specific drugs.

Thus, management of diabetes-related GI problems needs a multi-dimensional clinical approach to alleviative patient suffering.