The Link Between Ulcerative Colitis and Diabetes

When you have both ulcerative colitis (UC) and diabetes, it’s a balancing act. The two diseases can overlap and interact in frustrating ways, and sometimes treating one condition worsens symptoms of the other.

But there are strategies you can use to manage both diseases and reduce their impact on your daily life.

Diabetic colitis isn’t an official diagnosis. Diabetes does not cause colitis (inflammation in the colon), says Nicole Jawitz, MD, an assistant professor of medicine at Duke University School of Medicine in Durham, North Carolina, but people with diabetes “can develop colitis-like symptoms, including diarrhea, due to injury to the nerves in the GI tract.”

It’s also possible to have both UC and diabetes at the same time, and the two conditions can interact with each other.

Other causes of colitis-like symptoms in people with diabetes include medication side effects, artificial sweeteners, or other medical diagnoses.

Diabetes and UC can cause many similar complications.

• Problems with the liver and bile ducts: UC inflammation can contribute to primary sclerosing cholangitis, causing liver damage.

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   People with type 2 diabetes have a higher risk of bile duct infections and the hard lumps in the gallbladder known as gallstones.

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• Joint and bone problems: People with either condition have a higher risk of osteoporosis and bone fractures.

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• Blood vessel disease: Diabetes can lead to atherosclerosis, a stiffening and narrowing of blood vessels in the heart, brain, kidneys, eyes, and elsewhere.

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   UC can also increase a person’s risk of cardiovascular issues due to chronic inflammation and changes to the gut microbes.

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• Complications after surgery: Research suggests that a person with diabetes who undergoes surgery on the colon or rectum has an increased risk of complications, including infection at the surgery site and impaired wound healing.

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Medication Challenges

UC is typically treated with anti-inflammatory drugs, but some of these medications make diabetes management more challenging.

People taking glucocorticoids to manage a UC flare may need to manage their blood glucose levels carefully.

Diabetes Treatment Side Effects

• Diarrhea
• Nausea
• Vomiting

People can work with their healthcare provider to manage their treatment side effects and, if experiencing severe symptoms, find alternative treatments or undergo additional testing to rule out other causes.

Treatments and lifestyle changes for one condition can affect the other.

Dr. Jawitz advises treating the most active condition first during a flare-up of symptoms. “There may be periods when either a patient's ulcerative colitis or diabetes is more active,” she says. “In these cases, the acute treatment of one condition may be prioritized over the other. Otherwise, ideally both conditions should be routinely monitored and treated at the same time.”

If you’re looking for treatments for diabetes and UC, work with your doctor to find medications that won’t raise your blood sugar levels. Usually, doctors only prescribe glucocorticoids for a short time because of the risk of side effects.

• 5-aminosalicylates, like sulfasalazine (Azulfidine), which may lower A1C
• Biologics, such as infliximab (Remicade), which may reduce insulin resistance

Note that while the research on these medications thus far has been promising, more research is needed to definitely determine their effects on blood sugar levels and diabetes management.

• DPP-4 inhibitors
• GLP-1 receptor agonists
• Metformin

The best course of action is to take prescribed medications and avoid foods that aggravate your ulcerative colitis symptoms. Here are some other ways to manage both diabetes and colitis.

• Eat smaller meals.
• Limit your intake of high-fiber foods, which doctors often recommend for diabetes, as they can cause UC flares.

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   Avoid greasy or fried foods, too.
• Work with a team of healthcare providers, such as dietitians, gastroenterologists, and endocrinologists.

“For patients with both ulcerative colitis and diabetes, a gastroenterology evaluation can be very helpful in discerning the underlying causes of diarrhea and other GI symptoms,” says Jawitz. “An endocrinologist is similarly helpful in managing diabetes, particularly in the context of steroid use in treating ulcerative colitis, as this can result in uncontrolled blood sugar, decreased bone density, and changes in the body's natural neurohormonal signaling.”

Depending on your situation, the endocrinologist or primary care provider may use oral medications, such as metformin, instead of insulin.

• People can have both diabetes and ulcerative colitis, and these two diseases interact with each other. UC and diabetes also share complications, like potential liver and gallbladder issues and nerve damage.
• Steroids taken for UC can raise blood sugar levels, making diabetes management more difficult. People who take these medications may need to use stronger diabetes medications and keep a closer eye on their glucose levels.
• You may need a team of specialists to help you manage both conditions and find treatments and lifestyle changes that treat each disease without aggravating the other.