What causes diabetic diarrhea? How to cure it?

Young Woman Feeling Abdominal Pain
Medically reviewed by Dr. Ola Tarabzuni

Key Takeaways

  • Diarrhea is a prevalent symptom in individuals with diabetes, linked to factors like medication side effects and neuropathy. 
  • Diabetes disrupts digestive system nerves, leading to diarrhea. Possible causes include conditions like celiac disease, sugar-free sweeteners, neuropathy, pancreatic issues, and medication side effects. 
  • Effective management involves a multifaceted approach, focusing on controlling blood sugar levels and utilizing medications like loperamide. Lifestyle adjustments, adherence to prescribed medications, and a balanced diet play key roles in navigating and improving the challenges associated with diabetic diarrhea.

Overview

Diarrhea is a prevalent symptom among individuals with diabetes, attributed to factors such as medication side effects (e.g., metformin) and diabetes-related autonomic neuropathy. This blog explores the connection between diarrhea and diabetes, affecting about 20% of those with diabetes. The impact of diabetes on the digestive system and the unclear mechanisms leading to diarrhea are discussed. Effective management strategies, including the use of specific medications and controlling blood sugar levels, are crucial in alleviating this common complication, which may present as persistent or alternating with regular bowel movements or even constipation. Understanding and addressing diabetic diarrhea can significantly improve the quality of life for individuals managing diabetes.

What is diabetic diarrhea?

Diabetes is associated with various gastrointestinal issues, and diarrhea is a prevalent symptom, particularly in individuals with long-standing diabetes. This condition may also lead to fecal incontinence, especially during nighttime, attributed to nerve damage (neuropathy) affecting the anal sphincter—the muscle responsible for regulating the release of feces from the body. Understanding the link between diabetes and diarrhea is crucial for effective management, as it sheds light on the impact of neuropathy on bowel function.

Is diarrhea making your life difficult?
Get treated for diabetic diarrhea now.

What causes diarrhea in diabetics?

Diabetes causes high blood sugar, which can disrupt the nerves controlling the digestive system and end up causing diarrhea. However, the link between diabetic diarrhea is still unclear. Here’s the list of possible causes that can trigger diarrhea in diabetes: 

Celiac disease and microscopic colitis

Research suggests that individuals with diabetes have a heightened risk of conditions like celiac disease and microscopic colitis, with diarrhea being a potential symptom. In some cases, diarrhea may be the sole manifestation of these conditions.

Sugar-free sweeteners and ingredients

Consumption of sugar-free sweeteners, such as Sorbitol, mannitol, and xylitol, may elevate the risk of diarrhea due to their laxative effects. Diabetics should be cautious with these additives in various products. High consumption of artificial sweeteners, the use of metformin, and various dietary factors like sugar alcohols, celiac disease, bacterial growth, yeast infections, and exocrine pancreatic insufficiency can also contribute to diabetes-related diarrhea. Vigilance in managing these factors is essential for symptom control and overall well-being.

Pancreatic function and gastrointestinal disturbances

Diabetes affects pancreatic function, potentially leading to gastrointestinal disturbances. Conditions like pancreatitis, more prevalent in diabetes, may present with diarrhea as a symptom.

Diabetic enteropathy

Diabetic enteropathy, affecting the large intestine, is more likely to occur in people with diabetes. It can result in diarrhea, constipation, and fecal incontinence, contributing to gastrointestinal challenges.

Diabetes medication

Medications such as metformin and statins, commonly used in diabetes management, may affect intestinal function. Studies suggest that 15% to 24% of individuals taking metformin may experience diarrhea.

Bacterial overgrowth

Bacterial overgrowth in the gut, often associated with diabetic enteropathy, can lead to disturbances in intestinal function, potentially causing diarrhea.

Common causes shared with non-diabetics

Diabetics may also experience diarrhea due to factors common to both diabetic and non-diabetic individuals. These include allergies, food intolerances, long-term antibiotic use, and medications such as of certain antacids and cancer therapies.

Autonomic neuropathy and gastrointestinal function

Over time, diabetes-induced autonomic neuropathy can disrupt how food and fluids move through the colon, leading to diarrhea. This condition may also result in constipation alternating with diarrhea. Elevated blood sugar levels can lead to neuropathy, causing nerve damage in the small intestine and anorectal region. This damage may contribute to nighttime diarrhea and an increased likelihood of fecal incontinence. Diabetics may face additional intestinal challenges, including conditions like irritable bowel syndrome, which can contribute to diarrhea.

Intestinal issues

Problems in the small or large intestine can expedite the passage of fluids through the colon, causing more frequent and urgent bowel movements with watery stool consistency.

Risk factors to consider

Diarrhea exhibits a higher likelihood of occurrence in individuals with type 1 diabetes compared to those with type 2. Prolonged exposure to elevated blood sugar levels, particularly in diabetes that is challenging to manage, enhances the risk of diarrhea. Persistent hyperglycemia not only increases the likelihood of nerve damage but also elevates the overall complications associated with diabetes.

Moreover, individuals with diabetes who suffer from complications and associated disorders, including neuropathy, obesity, and pancreatic issues, face an elevated risk of experiencing diarrhea. In the aging population, specifically older adults with a lengthy history of diabetes, the frequency of diarrhea tends to be more prevalent. This increased susceptibility is attributed to the cumulative effects of diabetes over an extended period, emphasizing the importance of proactive management and monitoring for individuals in this demographic.

Diarrhea cause dehydration and loss of nutrients.
It worsens in diabetic patients.

How do you stop diarrhea from diabetes?

Effective management of diabetes-related diarrhea involves a multifaceted approach, primarily focusing on controlling blood sugar levels. Various medications and strategies can be employed to alleviate symptoms and reduce the likelihood of diarrhea from other contributing factors. Here is a list of possible treatment options for diabetic diarrhea:

Sorbitol reduction

Consuming fewer products containing the sweetener sorbitol is advised to mitigate the risk of diarrhea.

Medication options

Diabetic diarrhea can be treated with either antidiarrheal or diabetes-specific medicines, depending upon the patient’s condition. Here are some medication options: 

Antidiarrheal medications

  • Prescription Medication: Diphenoxylate and atropine (Lomotil®) can be prescribed by a healthcare professional. Additionally, clonidine (Kapvay) regulates bowel movements and reduces spasms, and amitriptyline is prescribed to reduce cramping and slow digestion.
  • Over-the-counter medication: Loperamide (Imodium®) is available without a prescription. Taking loperamide before meals can help manage diarrhea symptoms.

Diabetes-specific medications

  • Octreotide Acetate Injection: Administered through an injection, this medication reduces the frequency of diabetes-related diarrhea.
  • Antibiotics and Pancreatic Enzymes: Prescribed if the cause of diarrhea is identified as a bacterial infection or exocrine pancreatic insufficiency.
  • Setrons: Selective Serotonin 5-Hydroxytryptamine Type 3 (HT3) Receptor Antagonist, also known as setrons, these medicines not only treat diarrhea but can also address extreme nausea and vomiting.

Pelvic floor training and colostomy

For individuals dealing with fecal incontinence, practicing pelvic floor training and, in some cases, considering a colostomy may be recommended.

Consultation with a gastroenterologist

Depending on the severity of symptoms, a referral to a gastroenterologist may be suggested for further investigation.

Managing diabetes-related diarrhea

  • Blood Sugar Management: Follow the diabetes plan developed with your healthcare provider to optimize blood sugar levels.
  • Medication Adherence: Take prescribed medications as directed by your healthcare provider.
  • Balanced Nutrition: Consume whole foods, including whole grains and fiber, to support digestive health.
  • Hydration: Drink ample water to compensate for fluid loss during diarrhea.
  • Regular Exercise: Incorporate regular physical activity into your routine.
  • Lifestyle Adjustments: Quit smoking and tobacco use, limit alcohol consumption, and adopt a healthy lifestyle for overall well-being.

Navigating diabetes-related diarrhea involves a comprehensive approach that addresses symptoms, underlying causes, and lifestyle factors to enhance the quality of life for individuals managing diabetes.

What is the best instant relief for diarrhea?

When seeking rapid relief from diarrhea, over-the-counter (OTC) medications are effective and easily accessible. Two common options are Loperamide (Imodium) and Pepto-Bismol (bismuth subsalicylate). These medications work swiftly to alleviate symptoms, providing quick relief as: 

  • Loperamide (Imodium): This medication slows digestion, allowing the body to absorb more water from the intestines. Consequently, stools firm up, and the frequency of bowel movements decreases.
  • Pepto-Bismol (Bismuth Subsalicylate): Another OTC option, Pepto-Bismol, helps relieve diarrhea symptoms. It reduces inflammation in the intestines and has additional benefits, such as soothing an upset stomach.

In the absence of treatment, most episodes of diarrhea resolve spontaneously within a few days. It’s essential to monitor symptoms and seek medical attention if they persist or worsen.

Seeking instant relief through OTC medications is a practical and widely utilized approach for managing acute diarrhea. However, individuals experiencing prolonged or severe symptoms should consult a healthcare professional to determine the most appropriate action. 

Dehydration from diarrhea can cause stomach issues. Get prescription medications within minutes.

Consult a doctor

If you have diabetes and are suffering from issues such as frequent diarrhea, alternating bouts of diarrhea and constipation, or experiencing uncomfortable abdominal symptoms, it’s time to consult your healthcare provider. The connection between diabetes and diarrhea is common, and seeking medical advice is essential for effective management. Instances of diarrhea may also be linked to medications, such as metformin, commonly prescribed for diabetes.

Addressing these gastrointestinal issues with your healthcare provider is crucial for effective diabetes management. This dialogue allows for a comprehensive evaluation, including assessing your health profile, blood sugar levels, and potentially a physical examination to rule out other underlying medical conditions.

People with diabetes may deal with persistent diarrhea, characterized by loose and watery stools occurring at least three times a day. The added challenge of fecal incontinence, particularly at night, further underscores the need for medical attention. In collaboration with your healthcare provider, effective strategies, including medications and a suitable diet plan, can be tailored to relieve diarrhea symptoms and enhance overall well-being. Before starting any new medication or treatment, your healthcare provider must ensure that no additional gastrointestinal issues exacerbate the situation. Seeking guidance from your doctor facilitates a personalized approach to managing diabetic diarrhea, fostering optimal health outcomes.

FAQs about diabetic diarrhea

How long does diabetic diarrhea last?

Individuals with diabetes face an increased susceptibility to chronic or persistent diarrhea, known as “diabetic diarrhea.” The duration of this condition can extend from several weeks to several months. Causes may include medications for type 2 diabetes, dietary factors, or complications associated with diabetes. While diabetic diarrhea may linger for an extended period, appropriate treatment measures can effectively manage and alleviate symptoms. It’s not uncommon for individuals experiencing diabetic diarrhea to also contend with fecal incontinence during this period.

What does diabetic diarrhea look like?

Individuals with diabetes might encounter recurring episodes of diarrhea, characterized by loose and watery stools occurring at least three times a day. Additionally, fecal incontinence, particularly prevalent during nighttime, may accompany these instances. It’s important to note that metformin, a commonly prescribed diabetes medication, can also contribute to the occurrence of diarrhea in individuals with diabetes.

What foods to avoid with diabetes diarrhea?

To manage diarrhea in individuals with diabetes, it is recommended to exclude specific foods from the diet. Steering clear of fried and greasy foods, gassy options like broccoli, beans, prunes, and sugar alcohols used as substitutes can help prevent or alleviate symptoms. For those intolerant to lactose, avoiding milk is advisable. Additionally, minimizing the intake of caffeine, alcohol, and carbonated sodas is beneficial in controlling diabetes-related diarrhea. By adopting these dietary adjustments, individuals can take proactive measures to enhance their overall well-being and manage the challenges associated with diabetic diarrhea.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Ogbonnaya KI, Arem R. Diabetic diarrhea. Pathophysiology, diagnosis, and management. Arch Intern Med. 1990 Feb;150(2):262-7. doi: 10.1001/archinte.150.2.262. PMID: 2405798.
  • Frías Ordoñez JS, Otero Regino W. Diarrea crónica en el diabético. Una revisión de la literatura [Chronic diarrhea in the diabetic. A review of the literature]. Rev Gastroenterol Peru. 2016 Oct-Dec;36(4):340-349. Spanish. PMID: 28062871.
  • Burgers K, Lindberg B, Bevis ZJ. Chronic Diarrhea in Adults: Evaluation and Differential Diagnosis. Am Fam Physician. 2020 Apr 15;101(8):472-480. PMID: 32293842.
  • Kalra, S., Sharma, A. & Priya, G. Diabetic Gastroparesis. Diabetes Ther 9, 1723–1728 (2018). https://doi.org/10.1007/s13300-018-0475-4
  • Satoshi Murao, Hitoshi Hosokawa; Serotonin 5-HT3 Receptor Antagonist for Treatment of Severe Diabetic Diarrhea. Diabetes Care 1 March 2010; 33 (3): e38. https://doi.org/10.2337/dc09-2131

Get started today

Talk to online doctors now and get medical advice, online prescriptions, and referrals within minutes. On-demand healthcare services at your fingertips.

talk to online doctor 24/7 free