Type 1 Diabetes and Gastrointestinal Upset

Hello everyone!

I am studying nutrition in Arizona, and I am a type 1 diabetic.  It's often embarrassing to admit, but I have frequent gastrointestinal upset (abdominal pain after eating, frequent urges to have a bowel movement - as if us diabetics don't already have to run to go pee enough!, loose stools, flatulence, and reflux-type symptoms).

How many other people out there have these types of problems?  I have been reading research done on the subject, and some studies say that up to 50% of type 1 diabetics complain of these symptoms.  It could be caused by another set of hormones/enzymes that are relased from the pancreas other than insulin.  These are called exocrine pancreatic enzymes and they help us digest our food.  The problem also could be exacerbated by bacterial overgrowth in the intestines or intestinal neuropathy (if you have poor glucose control).

Anyway, if I get enough responses to this I hope that it will help me with working on my future academic research goals.  I would love to do research on this subject and see if I can raise awareness.  It is pretty dangerous to simply suffer through these gastrointestinal problems, since the nutritional and medical side effects that can become of it are fairly daunting.



I have it sometimes.  I have been diabetic for 31 years and have great control.  I was hospitalized twice for severe stomach upset.  They weren't sure if it was b/c of my diabetes, though.

Hey Christy, thanks for the response.

So does the problem seem to only come on severely at specific times, or does your problem seem to affect you more frequently, like every day?  week?  month?


Here's what I've gathered...I read about Celiac disease in a book at one point, and what I remember about the entry I read is that Celiac disease has to do with susceptibility in certain unfortunate diabetics (type 1 included) who found that certain foods (with fiber? gluten?) caused extremely unpleasant effects related to digestion.

I notice that stomach upset is terrible if I am forced to treat a bad low BG with solid food. So I instinctively avoid food in general until I have come up a little...I treat with liquid (although what I am reading about the posts here that talk about caffeine is making me question my entire approach) and then later, if I haven't spiked, I treat with a little food. I think this circumstance comes from (my best guess) the metabolism being sped up when low (having absolutely no scientific justification for that statement)...although I certainly could not do that if I were taking N and R still. I had to eat with the long-acting/slow-acting insulin. And I had pretty much chronic stomach issues...but then again, I'd been doing insulin injections for 14 or so years, so perhaps this was somehow related to the spanse of time where I was dealing with type 1. With rapid insulin in an infusion pump, I almost can't eat to treat lows...maybe I'm out on a limb here, but it seems to be pretty devastating systemically. I still get violently ill at times, but nowhere near as often as it used to happen...it wasn't fun.

When my BG is high, I become both dehydrated and in turn experience havoc in pretty much every fluid-utilizing process (well, aren't they all), most especially digestive issues. Food allergies are so prevalent now as well...but I feel like my control of both symptoms related to lows and highs as well as stomach issues (which can take any day to a grinding halt) necessitates fiber: brown foods make me happy, somehow. In fact, I am rather fond of whole wheat/brown rice, etc. If I go for a while without some sort of fiber food (ie. McDonald's back and forth to work), I tend to become more prone to stomach issues.

I won't get into diet any more because people are surprisingly (occasionally) rabid about food intake, but the fiber ratio thing with carb counting causes its own series of problems related to lows...

I wish people who suffer from such circumstances some better fortune in the future; it's hard to talk about, and I applaud your openness with regards to this circumstance. I wouldn't have dared talk to the endo (when I had one...long story), but then again, this was not the most balanced person to begin with (my endo).

Celiac disease is an autoimmune disorder like type 1 diabetes. In fact some of the most JDRF sponsored research point to a high genetic similarity between the two diseases, and the chances for a T1 diabetic to have celiac as well is much higher than the general population.

Celiac Sprue is a gluten intolerance. There's a protein called gliadin that is in wheat, malt, barley and rye that cause an autoimmune response in patients with celiac. In Type 1 diabetes, your autoimmune system gets confused and attacks the insulin producing cells in your pancreas. In celiac, your immune system get's "triggered" by gluten in your digestive system and attacks the lining of your small intestine. This causes terrible cramps, bowel distress, but most importantly, you can't absorb any of the nutrients from the food you eat.

The good news is that there's a cure for celiac disease: a gluten free diet. It's a pain to check out the ingredients of everything you eat and to have to be careful of what to order in restaurants, but as a family dealing with diabetes we do that anyway. The even better news is that your digestive system's lining gets ***completely*** regenerated after only 6 months on the diet.

There are blood tests (like the antigliadin antibody test) and an intestinal biopsy that can be done to see if you have this disease. But you should talk to your endocrinologist and possibly have her refer you to a good gastroenterologist to make the determination.

I find that if I eat certain foods(dont know what they are) I get gas issues, especially around lunch time.

Hey Courtenay, try to see if the high-fat meals are the ones that give you the gas.  If this is the case - like mine - then taking pancreatic enzymes may help quite a bit.

Crochet nut, your comment "I wish people who suffer from such circumstances some better fortune in the future" I couldn't agree more with.  I think that raising awareness and approaching the issue is a big step that needs to be made.  People won't normally talk about these types of problems, even when it is significantly affecting their quality of life.  Thanks for all of your advice.

Red, I actually first went to the doctor with my complaints thinking I actually was a Celiac - based on my symptoms.  But I didn't have the Celiac antibodies or any typical undiagnosed Celiac anemia.

Currently, I'm taking pancreatic enzymes (the digestive ones that cystic fibrosis patients normally take) and probiotics.  The enzymes seem to have made a big difference, but I still think I may require a larger dose.

Thanks for all of the responses, and here are some links to research studies on the topic if anyone is interested (you may only be able to view the abstract if you don't have a subscription or free access from a university's library):


Some of the findings I found interesting were:

"The data suggest that mild to moderate exocrine pancreatic insufficiency found in type-1 diabetes is due to an early event in the course of the diabetes and does not progress."
"Nonpancreatogenic steatorrhea was present in two thirds of the patients and was probably caused by bacterial overgrowth."
"The main finding of our study is that PE-1 is significantly lower in type 1 diabetic subjects and confirms the frequent occurrence of an exocrine pancreas deficiency in these patients."
"In our study, 5 of 16 patients were treated with antihypertensive agents (ACE inhibitors in 4 and an angiotensin II receptor blocker in 1). These five subjects had lower PE-1 values than patients without such treatment"
"Exocrine insufficiency seems to be correlated to early onset of endocrine failure, long-lasting diabetes mellitus and low body mass index levels."
"A reduction in mild and moderate hypoglycemia was observed in the pancreatin group at the end of the study. Conclusions Pancreatin therapy can be used safely in patients with diabetes mellitus and exocrine dysfunction. Parameters of glucose metabolism were not improved by enzyme replacement therapy."

Call me crazy... Research excites me.  :)

I have had type 1 diabetes for 17 years.  I started having severe stomach pain after starting to take Symlin.  After a stint in the hospital I stopped taking it.  But I still occassionally have stomach pain.  It seems to be the worst when eating high fat foods or alcohol.  My doctor diagnosed it as acid reflux though it is not acidic and the medicine does not do anything to help. 

Hey Jsirwin... if it is worse after high fat meals and/or alcohol it may be a liver problem, too.  The liver releases bile to emulsify fat so it can later be digested by the pancreatic enzymes and alcohol is also metabolized in the liver.

Sometimes my problem will present as stomach burps and acid reflux too... I wonder if we may have the same problem going on.  I've never noticed any stomach pain after alcohol, but I'll have to keep that in mind and see if I actually do but just haven't noticed it.

Hey, I just ran across this posting as I am new here but I would like to help if I could. I am a T1 as well going on my 8th year since diagnosis. I have recently within the last 6 months begin more obvious symtoms myself. In my case its such severe nausea and pain in my abdomen, I find it hard to sleep or eat at times. I never even hard of this before a year ago and am trying to understand it much better and find out what I can do to help, any suggestions?

I have been having ongoing stomach problems for a while they are testing me for celiac on my next blood test. they tested me for this a while ago and no celiac but it seems to be getting worse so maybe they will see something on this test

I hope it isnt a double whammy.

I think you should definitely talk it over with your doctor, Jess.  It could be so many things that it a sure case that you'll need to have a lot of blood working and testing to try to figure out what is wrong.  If the doctor doesn't find anything, then do a lot of research on it yourself.  I've found that a lot of diabetics have other autoimmune diseases as well, oftentimes such as Celiac's, then it could be a problem with the other hormones that digest your food from your pancreas - this would cause maldigestion and pain as well - or it could be something else entirely.

The point is - talk it over honestly with your doctor and see what you two can find out together.  Don't be nervous to tell him any of your symptoms, even when it is uncomfortable.  The best treatment plan requires complete honesty on your part + a good doctor.


And Gina, sorry to hear you are still having the GI upset.  If it is Celiac's disease, you'll have a whole new game to play.  Not only will you have to count carbs, but you will have to make sure that none of them contain gluten!  Sorry,  not to play at it - I know it is such a hard thing - but being positive is basically all we have here in juvenation.  :)

Hi, I'm very new to this site.... I hope I'm replying the right way. 

Anyway, I was diagnosed with Type 1 11 years ago when I was 13 and then I was diagnosed with celiac when I was 16.  There was a study going on at children's hospital in Vancouver, bc and so I was tested.  It came back positive and so I had the endoscopy done.

It use to be hard finding gluten free foods but there is more becoming available everywhere.  It is difficult having both because  a lot of gluten free foods are high in carbs and often do not have the nutritional value on the packaging.

If anyone has any more questions about it, let me know.. I'm not an expert by any means but I can talk from experience with living with celiac.  

I know you posted this a long time ago but if your doing research....My son, kindergartener dx at 3, has had a lot of trouble with reflux since he was a baby but it has never stopped.  He has been tested for Celiac and came up negative.  He was on meds for a year or two, we decided to wean from them and see what happened and have been able to mostly control with diet and tums.  It is hard for me to tell how much in control it is as he is not a big complainer of anything.  (makes it hard to tell lows too).  My uncle who is a pediatrician has a theory that T1 children are often "hypersensitive" to their environments.  Whether it be acidic/greasy foods or insect bites, T1 bodies are more likely to overreact.  I also saw your post on the dark circles.  Lucas also has these on a regular basis - our other nonT1 boys do not.  We were going to have hime tested for allergies (thinking they were allergenic shiners), when they are most pronounced, his sugars are off (high or low) we thought the allergen triggered his sugars to go off. 


I have allergies as well, severe ones to shrimp and lobster.  The hypersensitivity hypothesis definitely has a lot of basis in the overlap of the autoimmune diseases.  Type 1 diabetics have a much higher risk of suffering from the many autoimmune diseases (crohn's, celiac's and ulcerative collitis among the many) that will cause gastrointestinal malaise than other non-type 1 diabetics.

I hope Lucas is able to find some relief.

An update on my situation:
Pancreatic enzymes right before meals and a good supplement of probiotics every morning has helped IMMENSELY.  I am very happy with the treatment plan my doctor and I have decided upon.

I have a good deal of the symptoms you mention.  Even after going vegan and avoiding artificial sweeteners I still have issues.  Those close to me have just accepted that I go to the bathroom more than anyone they know.  

Hey Eric, definitely ask your doctor if he thinks you have pancreatic enzyme insufficiency.  It also may be worth your time to ask him/her about getting test for Celiac's if you never have before.  It's not something you should go on living with - both disease states can cause malnourishment.

My daughter was much the same.. we had trouble with everything as an infant and diagnosed at 23 months and celiac negative. She complains about her tummy all the time.  She too seems to have sensory dysfunction, digging.. bug bites, knawing at her hands, tummy troubles, and sensitive to clothing etc..  She's being tested for celiac again in a couple weeks and we think we'll need to screen her for therapy related to the sensory issues too.. She'll scratch her pump sites right off, have her medical id in her mouth at all times, or play with it.. lots of crying and meltdowns over the tiniest thing (or so it looks).  I'd be interested in seeing data or research on this as her diabetes dr thought it was just her.

I suffered with really bad GI problems starting when I got appendicitis and had an appendectomy. My initial thoughts were maybe it was the result of antibiotic use, but the problem continued for months following the surgery and stopping the antibiotics. I was put on medications to try to try to reduce the frequency with which i was going (things like Levsinex), I had lots of testing done (checking for things like celiac disease or enteroviruses), and I even had a colonoscopy (the prep for this test is the most awful thing ever!). Everything came back negative. The doctors said it was probably irritable bowel or 'diabetic diarrhea'. At any rate, after about 8 months of dealing with that, my system normalized itself and now my GI system is back to normal (Thank God!)!.

Kylie03mom, I'm not a medical expert, but you might want to look at prader willi syndrome, it's one of the few conditions I know about with high pain tolerance.  Here's a link to the mayo clinic page on it:  http://www.mayoclinic.com/health/prader-willi-syndrome/DS00922/DSECTION=symptoms