The problem with defining gut symptoms is that they are very varied and can be caused by a whole host of different disorders other than diabetes. These include indigestion due to acidity or peptic ulcers, longstanding constipation and changing bowel habit or bloating due to irritable bowel syndrome. Bowel symptoms however, are also quite common in people with diabetes due to the effect of high blood glucose on the nerves controlling intestinal contractions. In any event an assessment of gut symptoms is likely to need a wide range of clinical skills in sorting out what is due to diabetes and what is not.

A common presentation of gut problems is bloating and constipation. These symptoms could have a simple answer such as being due to a side effect of one of the diabetes medicines. Alternatively, the symptoms may be due to constipation which in turn is much more likely if high blood glucose results in dehydration. There may also be a nutritional explanation for the symptoms and it not unusual to enlist the help of a dietician and a specialist gastroenterologist to distinguish between the various possibilities.

A distressing and specific diabetes related problem is called gastroparesis. This is when stomach emptying is not coordinated properly with the contractions of the rest of the intestine. The resulting nausea and episodes of vomiting are very difficult to manage especially with the matching of food and insulin requirements. Thankfully there is now good research in this area and gastroenterologists have a number of strategies available to treat this difficult problem.