In addition, hypermotility caused by decreased sympathetic inhibition, pancreatic insufficiency, steatorrhea, and malabsorption of bile salts can further contribute to diarrhea. Abnormal internal and external anal sphincter function caused by neuropathy can lead to fecal incontinence.

When evaluating a patient with diabetes who has diarrhea, drug-related causes e. Treatment of diabetic diarrhea is mainly empiric and directed toward symptomatic relief, such as correcting fluid and electrolyte imbalances, improving nutrition and blood glucose control, and managing any underlying causes.

Broad-spectrum antibiotics have been used for the treatment of diarrhea, but there are no well-designed studies to support their use. Constipation, which may alternate with diarrhea, is one of the most common complications of diabetes. A population-based study found that 20 to 44 percent of patients with diabetes reported symptoms of constipation or increased use of laxatives.

It is important to rule out other causes of constipation such as hypothyroidism or medications. A thorough history and physical examination, including a rectal examination, should be performed.

Treatment includes good hydration, regular physical activity, and increased fiber intake. Sorbitol or lactulose can also be used to treat constipation; saline or osmotic laxatives may be needed in more severe cases. Nonalcoholic fatty liver disease is the term used to describe a liver condition in patients who have a pathology resembling alcohol-induced liver injury but lack a history of significant alcohol consumption.

The etiology is unknown, but the disease is often associated with type 2 diabetes and obesity. In some cases, nonalcoholic fatty liver disease may progress to nonalcoholic steato-hepatitis with varying degrees of inflammation and fibrosis. In very rare cases, it can lead to cirrhosis. All patients who are severely obese and who have diabetes have some degree of steatosis, with one half having steatohepatitis.

Nonalcoholic fatty liver disease is generally diagnosed because of persistent elevation in hepatic transaminase levels. Patients with elevated levels should have serologic testing to exclude hepatitis, an antinuclear antibody test to exclude autoimmune hepatitis, and a transferrin saturation test to exclude hemochromatosis.

Ultrasonography or computed tomography showing characteristic changes in a patient who uses little or no alcohol confirms the diagnosis. Most patients with nonalcoholic fatty liver disease are asymptomatic. Although some may experience malaise or right upper-quadrant fullness, it is unclear whether this is caused by the disease or by comorbidities e.

A longitudinal study was conducted to evaluate the histologic course of patients with nonalcoholic fatty liver disease who underwent serial liver biopsies. Researchers found that fibrosis stage remained stable in 34 percent, progressed in 37 percent, and regressed in 29 percent of patients.

Changes in aminotransferase levels did not parallel changes in fibro-sis stage. However, patients with diabetes, an elevated body mass index, and fibrosis were at risk of higher rates of progression.

Gradual weight loss approximately 1 to 2 lb [0. A statistically significant improvement of nonalcoholic steatohepatitis histology was seen in one small study of pioglitazone Actos , 26 but this drug is not approved by the U. Food and Drug Administration FDA for use in patients with liver disease.

Because good evidence is lacking, routine use of these drugs simply to normalize hepatic transaminase levels is not recommended. Diabetes is more common in patients with hepatitis C infection than in the general population.

In one study, the estimated prevalence of diabetes in patients with hepatitis C was found to be Causes of cirrhosis linked to diabetes include nonalcoholic fatty liver disease, hemochromatosis, and hepatitis C infection.

Patients with cirrhosis and diabetes may show signs of increased insulin resistance and may require high doses of insulin to control their blood glucose levels. Troglitazone Rezulin , a thiazolidinedione, was withdrawn from the market because of hepatotoxicity. Therefore, the FDA recommends not using thiazolidinediones in patients with liver disease.

In rare cases, sulfonylureas e. The prevalence of idiopathic hemochromatosis is 9. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. Bytzer P, Talley NJ, Leemon M, et al. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15, adults.

Arch Intern Med. Bytzer P, Talley NJ, Hammer J, Young LJ, Jones MP, Horowitz M. GI symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications.

Am J Gastroenterol. Rayner CK, et al. Relationships of upper gastrointestinal motor and sensory function with glycemic control.

Diabetes Care. Ebert EC. Gastrointestinal complications of diabetes mellitus. Dis Mon. Lluch I, Ascaso JF, Mora F, et al. Gastroesophageal reflux in diabetes mellitus. Camilleri M.

Clinical practice. Diabetic gastroparesis [published correction appears in N Engl J Med. Yoshida MM, Schuffler MD, Sumi SM. There are no morphologic abnormalities of the gastric wall or abdominal vagus in patients with diabetic gastroparesis.

Ordög T, Takayama I, Cheung WK, Ward SM, Sanders KM. Remodeling of networks of interstitial cells of Cajal in a murine model of diabetic gastroparesis. Parkman HP, Hasler WL, Fisher RS, et al. American Gastroenterological Association technical review on the diagnosis and treatment of gastro-paresis.

Tougas G, Chen Y, Coates G, et al. Standardization of a simplified scintigraphic methodology for the assessment of gastric emptying in a multicenter setting. Quigley EM, Hasler W, Parkman HP. AGA technical review on nausea and vomiting. Abell TL, Bernstein RK, Cutts T, et al. Treatment of gastroparesis: a multidisciplinary clinical review.

Neurogastroenterol Motil. Jebbink RJ, Samsom M, Bruijs PP, et al. Hyperglycemia induces abnormalities of gastric myoelectrical activity in patients with type 1 diabetes mellitus. Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract.

Galligan JJ, Vanner S. Basic and clinical pharmacology of new motility promoting agents. Degen L, Matzinger D, Merz M, et al. Tegaserod, a 5-HT4 receptor partial agonist, accelerates gastric emptying and gastrointestinal transit in healthy male subjects.

Aliment Pharmacol Ther. Anand C, Al-Juburi A, Familoni B, et al. Gastric electrical stimulation is safe and effective: a long-term study in patients with drug-refractory gastroparesis in three regional centers.

Jones MP, Maganti K. A systematic review of surgical therapy for gastro-paresis. Maganti K, et al. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Virally-Monod M, Tielmans D, Kevorkian JP, et al. Chronic diarrhoea and diabetes mellitus: prevalence of small intestinal bacterial overgrowth.

Diabetes Metab. Maleki D, et al. Pilot study of pathophysiology of constipation among community diabetics. Dig Dis Sci. American Gastroenterological Association. American Gastroenterological Association medical position statement: nonalcoholic fatty liver disease. Adams LA, Sanderson S, Lindor KD, Angulo P.

The histological course of nonalcoholic fatty liver disease: a longitudinal study of patients with sequential liver biopsies. J Hepatol. Angelico F, Burattin M, Alessandri C, Del Ben M, Lirussi F. Cochrane Database Syst Rev. Basaranoglu M, et al. Of Canadians who are at a normal, healthy weight, only 3.

The body mass index BMI is a calculation used to provide a rough estimate of whether an individual or a population group is underweight, healthy weight, overweight, or obese. For example, if you are 1. Diabetes and Gastroparesis Diabetes is the leading cause of gastroparesis , a digestive condition in which food remains in the stomach for too long delayed gastric emptying , rather than passing into the small intestine when it should.

High blood sugar from diabetes can cause chemical changes in the vagus nerve, which connects the brainstem to the gastrointestinal tract.

Diabetic gastroparesis is an especially dangerous form of gastroparesis, because the delayed gastric emptying can lead to periods of very high or very low blood sugar, continuing to worsen the vagus nerve damage. Gastroparesis symptoms include nausea, vomiting, reduced appetite, feeling full after eating small amounts of food, abdominal pain, and heartburn.

Nutrient deficiencies are common, and these can lead to fatigue, weight loss, and anemia. In some cases, excessive vomiting can cause severe dehydration.

Diabetes is the most common cause of a serious condition known as autonomic neuropathy. Diabetic autonomic neuropathy involves peripheral nerve dysfunction, and affects many parts of the body, with significant gastrointestinal symptoms. Diabetic autonomic neuropathy often affects the cardiovascular system, respiratory system, and other parts of the body, but we will be focusing on its effects on the digestive tract.

As mentioned in the section on gastroparesis, diabetes can affect proper functioning of the nervous system. When neuropathy affects the enteric nervous system, which is the nervous system of the gut, it can cause many digestive symptoms including constipation, diarrhea, fecal incontinence, and esophageal dysmotility.

There are currently no treatments available to effectively reverse the progression, so prevention is extremely important. The best way to prevent diabetic autonomic neuropathy is to ensure that your blood sugar levels are always under control. While it is unclear exactly what the relationship is, some research has found that those with celiac disease are more likely than the general population to develop type 1 diabetes.

One study found that type 1 diabetes affected only 0. The pancreas is the organ responsible for producing insulin. The medication metformin revolutionized type 2 diabetes treatment and is the most widely used oral diabetes medication.

Although it was discovered in , human studies did not take place until s. It was introduced as a medication in France in , Canada in , and the United States in Individuals with milder cases of diabetes can take metformin with relatively few side effects to manage their blood sugar levels.

However, metformin has some notable side effects in the digestive tract, including diarrhea, fecal urgency, nausea, and abdominal pain. These symptoms often disappear after the individual adjusts to the medication, but in some cases, diarrhea can last for a long time.

It is also common for diarrhea to cease if the patient stops taking metformin, then to return if they resume metformin. The upside is that metformin has been shown to have other benefits such as lowering cholesterol, improving erectile dysfunction, and reversing fatty liver disease.

Many individuals with diabetes choose to consume artificially sweetened treats in lieu of those containing sugar. However, it is important to note that a certain type of artificial sweetener, known as sugar alcohols, can cause diarrhea.

Avoid large quantities of these products to reduce diarrhea.

Without keeping track of your blood glucose levels all the time, you may not know if you have hyperglycemia. The good news is, your body will send you clues that your blood glucose levels are too high.

Common signs and symptoms of hyperglycemia include: 5. Even if you do not experience signs and symptoms of hyperglycemia, it is important to be tested regularly for diabetes. Diabetes is rampant around the world and often goes undiagnosed because it can take years for symptoms to develop.

Your functional medicine doctor can order an A1C test — also known as a hemoglobin A1C test — to determine if you have diabetes. The test measures your average blood glucose levels over the past three months. An A1C level of 6.

An A1C of 5. You can also get a basic at-home lipid panel test. The results are available online so you can share them with your functional medicine doctor.

New research suggests high blood glucose can increase intestinal permeability, alter the gut microbiota, and increase the risk of gut infections or even autoimmune disease. In other words, hyperglycemia and leaky gut are connected. One study found that elevated glucose alters the integrity of the intestinal epithelial barrier, which is needed to protect us against bacteria, inflammation, and infection.

Researchers also found that hyperglycemia caused significant changes in the gut microbiome and increased the risk for gut infections that cause intestinal illness. The interesting part of this research is that it was found that once high blood glucose levels were corrected, the gut microbiome began to restore itself.

Since intestinal permeability can lead to systemic inflammation, it can also lead to leaky gut syndrome and is a precursor to autoimmune disease and diabetes. The good news is, following a healthy diet, keeping tight control of blood sugar and prioritizing your gut health can help protect your intestinal barrier and prevent leaky gut syndrome.

Think of your gut as a drawbridge. Your gut is naturally semi-permeable to let teeny-tiny boats micronutrients pass through your intestinal wall and into your bloodstream. Certain external factors, including food, infections, toxins, and stress, can break apart the tight junctions in your intestinal wall, leaving the drawbridge open.

Once this happens, you have a leaky gut. When your gut is leaky, much larger boats that were never meant to get through toxins, microbes, and undigested food particles can escape into your bloodstream.

A properly functioning digestive system is critical to good health. Problems in our gastrointestinal GI tract can cause more than just stomach pain, gas, bloating, or diarrhea; they can be the root cause of many chronic health problems.

Take this quiz to find out! Whether you are on the low end of the spectrum with the occasional hyperglycemia or are diagnosed with type 2 diabetes, you can take back control of your health, and it starts with repairing your gut. Here are natural ways to regulate glucose levels.

As I mentioned earlier, stress is a primary cause of hyperglycemia. When your body is under increased levels of stress it releases the hormone cortisol.

This sets off a chain reaction that tells your adrenal glands to produce cortisol. Cortisol mobilizes glucose reserves for energy and facilitates the consolidation of fear-based memories so you can survive in the future and avoid danger.

However, too much cortisol can suppress the immune system and increase blood pressure and blood glucose levels, and contribute to diabetes. Your body is just not designed to live in fight or flight mode all the time.

It needs to rest and relax to function optimally. Adopting daily stress-relieving strategies will help you get your blood glucose levels under control.

Some of my favorite ways to relieve stress include getting in my Sunlighten infrared sauna, dancing with my daughter Elle, listening to music, or taking a walk with my family and our dogs Mocha and Mac.

I recommend everyone remove gluten and dairy from their diets. You should also avoid processed foods and sugary drinks. You likely are aware that soda, energy drinks, and those fancy coffee drinks and teas all contain a huge amount of carbohydrates and sugar.

Yet even options you think are healthy, including green juices, kombucha, and even freshly-squeezed fruit juice, all pack in the sugar. Alcohol is toxic to all of us and if you have diabetes it can damage your liver even more.

Remember, if your liver is having to work too hard to filter sugar, it cannot filter out toxins. Rest assured, there are great, delicious foods you can eat if you have hyperglycemia.

I cannot stress enough the importance of physical exercise if you have hyperglycemia or diabetes. Our bodies function at their best when we exercise regularly.

If you are overweight, which contributes to diabetes in the first place, exercise can help you manage your weight and control your blood sugar. Movement helps lower blood glucose, reduces your risk for heart disease, reduces stress, and alleviates depression. If you have diabetes, consult with your functional medicine practitioner before starting an exercise routine.

Remember to start slow. You may need to discuss how to manage any medication with exercise if you are on diabetic medication that already lowers blood glucose levels.

Start by creating a routine by setting a time every day to exercise. Generally, 30 minutes of movement is needed to get the benefits. There are many online fitness options available, and the best part is you can do them in your home with little to no equipment. Canned goods are great hand weights for strength training!

Be sure you take care of your feet. Because diabetes can cause numbness in the extremities, it could be difficult to know if your feet are suffering during exercise. Leaky gut leads to inflammation that can cause a slew of issues, including gastric problems, acne, and dandruff. At its most extreme, it can lead to autoimmune diseases such as lupus and multiple sclerosis.

This starts by repairing your gut. The 4R approach is a proven approach that I recommend to all of my patients to begin repairing their gut.

A quick note about type 1 diabetes and L-glutamine. Some studies suggest that L-glutamine supplementation can lead to hypoglycemia low blood sugar in people with type 1 diabetes with no insulin secretion, especially after exercise. If you have type 1 diabetes, talk with your doctor before taking supplements that contain L-Glutamine.

My number 1 tool to repair your gut is Leaky Gut Revive® , which also comes in a delicious Strawberry Lemonade flavor. I drink a glass of Strawberry Lemonade Leaky Gut Revive® every day. Leaky Gut Revive® , is a natural, 6-in-1 physician-formulated blend of nutrients designed to soothe and repair your gut quickly.

Formulated with pharmaceutical-grade L-glutamine and a unique combination of restorative botanicals, Leaky Gut Revive® combats the root cause of leaky gut — resulting in reduced belly bloating, smoother digestion, a repaired gut lining, and a healthier appearance overall.

I have seen thousands of my patients take back their health, and you can too! The relationship between the foods that we eat, hyperglycemia, and leaky gut all share a fascinating connection. Repairing your gut and regulating blood glucose levels are the first steps in restoring your health.

It is a symptom of diabetes. The findings , published Feb. The new evidence also clarifies the scientific debate about the connection between communities of bacteria living in the intestinal tract, called the gut microbiome, and energy expenditure.

Results from previous studies have been mixed. Some high-profile papers have concluded that gut microbes affect glucose levels by increasing energy expenditure; others said they decreased it. Then we found a less complicated, more direct relationship between gut microbes and glucose levels through the liver.

Changes in the gut microbiome are associated with metabolic disorders such as obesity, insulin resistance and diabetes, conditions that involve an impaired ability to maintain proper glucose levels in the blood.

Blood glucose is a source of energy for all tissues in the body. Its levels are controlled by a complex interplay of hormones in response to different conditions, such as food intake and exercise. For example, when blood glucose dips too low, the liver releases a stored form of glucose called glycogen and it can also use amino acids to produce glucose if necessary.

For their study, the investigators performed a series of experiments using mice whose gut bacteria had been depleted, as well as mice bred to have no microbes in their bodies and normal mice. They exposed the mice to a range of temperature and feeding conditions such as exposure to cold and eating a high-fat diet, which caused them to expend different levels of energy.

The team evaluated energy expenditure with a broad range of measures including resting metabolic rate, core temperature, oxygen consumption and carbon dioxide production, body composition and nutrient absorption.

They also transplanted fecal microbes from mice kept in colder conditions into mice housed at normal temperatures. Next, the researchers, including co-lead author Dr. Hayley Nicholls Krisko , an assistant professor of metabolism research in medicine at Weill Cornell Medicine, examined the pathways that affect sugar metabolism in the livers of mice with depleted microbiomes compared to normal mice, and found distinct differences.

They then looked in the portal vein, which carries blood from the gastrointestinal tract to the liver, and found that that there is likely at least one molecule produced by gut microbes that controls how the liver sends glucose into the blood.