Crohn’s Disease and Diabetes — How They’re Related

People with Crohn’s disease are more likely to develop diabetes compared to the general population. The link between these conditions is a common topic among the members of MyCrohnsAndColitisTeam.

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“I was wondering if anyone else has diabetes because of their bowel disease,” one member posted. Another replied, “That is an interesting question — I never thought of diabetes and digestive disease going hand in hand. I was diagnosed with Crohn’s in 2010, and then in 2012, I was diagnosed with Type 2 diabetes.”

If you’re living with Crohn’s disease, it’s important to understand the possible connections between your condition and diabetes. Read on to learn what you need to know.

What Is Diabetes?

Diabetes, also called diabetes mellitus (sugar diabetes), is a chronic disease that causes hyperglycemia, or high blood sugar. In diabetes, the body does not properly metabolize sugar so the body can use or store it.

High blood sugar levels from diabetes contribute to other diseases and can cause many symptoms throughout the body. Some of the possibilities include:

• Stroke
• Heart disease
• Kidney disease
• Nerve damage
• Eye damage
• Impaired immunity

Types of Diabetes

There are two main types of diabetes — type 1 and type 2. Both of these types of diabetes are caused by the inability of cells in the body to absorb blood sugar (glucose) so it can be converted into energy (metabolized) or stored for later use.

When glucose cannot be processed by the body, it remains in the blood, where it can cause damage over time. Certain other conditions, such as pregnancy and cystic fibrosis, can also cause less common types of diabetes.

Type 1 Diabetes

Type 1 diabetes occurs because the body cannot produce enough insulin. Insulin is a hormone needed for glucose (blood sugar) metabolism and storage. It is normally produced by cells in the pancreas, an organ involved in metabolism.

It is believed that type 1 diabetes is an autoimmune disease. In an autoimmune disease, the body mistakenly sees certain cells as foreign — and dangerous — to the body. In response, the body makes antibodies to destroy these “intruders.”

Genetic and environmental risk factors, such as viral infections, may spur the development of type 1 diabetes. This type of diabetes is usually diagnosed in children, teens, and young adults. Type 1 diabetes is treated with daily insulin injections to replace what the body is unable to make.

Type 2 Diabetes

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The pancreas produces insulin, the hormone necessary for cells to use glucose in the blood for fuel. In people with type 2 diabetes, cells are resistant to insulin. When cells can no longer take up glucose, blood glucose levels rise. Sensing more blood glucose to process, the pancreas makes more insulin, and the cycle keeps going.

The term for this — when cells in the body do not respond to insulin as they should — is insulin resistance. The precise reason someone’s cells would be insulin resistant is unknown. But several parts of the equation that lead to type 2 diabetes have been identified. Increased risk of type 2 diabetes is associated with medical, lifestyle, and environmental factors, such as being overweight or obese, having excessive abdominal (belly) fat, and physical inactivity. Family history, race, and age (over 45) are also risk factors.

Type 2 diabetes is usually diagnosed in adults, but is increasingly being seen in children and teens. Along with changes in diet and exercise, type 2 diabetes can be treated with several different types of medications (like metformin, which is sold under several brand names). A person with type 2 diabetes might also need to take insulin.

Symptoms of Diabetes

According to the National Institute of Diabetes and Digestive and Kidney Diseases, symptoms of both type 1 and type 2 diabetes can include:

• Increased thirst and hunger
• Increased need to urinate
• Vision problems (like blurred vision)
• Weight loss with no explanation
• Changes in sensations (like feeling numb or tingly in the hands or feet)
• Unusual fatigue
• Wounds take longer to heal

Diagnosing Diabetes

Simply put, diabetes is diagnosed by testing for high blood sugar levels. Several blood tests can be used to diagnose diabetes.

The gold standard for diagnosing diabetes is the hemoglobin A1C test, which reflects a person’s average blood sugar levels over the past two to three months. Other blood tests used to diagnose diabetes directly measure blood sugar levels.

These include:

• Fasting plasma glucose test — measures blood sugar after eight hours of no food or drink
• Random plasma glucose test — measures blood sugar at any given time in the day
• Oral glucose tolerance test (OGTT) — measures blood sugar before you drink a prescribed sweet liquid and after your body has had a chance to process it

Fasting and random blood sugar levels are often part of normal blood test panels. An OGTT may be used in people with borderline blood sugar levels. A test similar to the OGTT is used to check for gestational diabetes (diabetes caused by pregnancy).

Crohn’s Disease and Diabetes Risk

Research has found that Crohn’s disease is linked to both type 1 and type 2 diabetes. The following studies illustrate the proof.One Danish study of more than 3,000 people with inflammatory bowel disease (IBD) found that a person with either Crohn’s disease or ulcerative colitis (UC) had an increased risk of developing type 2 diabetes.

Another study, this one from Korea, compared the medical histories of more than 8,000 people with Crohn’s or UC to see if the records revealed any connection between the two and diabetes. Of the two, the scientists said Crohn’s, not UC, was tied to increasing someone’s risk of developing diabetes.

In Germany, a separate group of scientists studied the cases of thousands of young people (under 18 years old) with type 1 diabetes. The conclusion? The youth were at higher risk of developing either Crohn’s disease or ulcerative colitis as compared to young people without type 1 diabetes.

This Germany-based team also saw that the youth with both type 1 diabetes and IBD were more likely to have lower body weight and episodes of severe low blood sugar. Further, they noted this group of the double-diagnosed were more likely to have been treated with corticosteroids.

What Do Crohn’s and Diabetes Have in Common?

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There are several ways that diabetes and Crohn’s are linked beyond one simply increasing the incidence of the other.

Both Crohn’s and type 2 diabetes involve inflammation of the gastrointestinal tract and an abnormal gut microbiome (the bacteria and fungi that live in the intestines). Diabetes and IBD involve some of the same proinflammatory cytokines (chemical messengers that promote inflammation), including TGF-beta (transforming growth factor-beta).

Crohn’s disease and diabetes also share some common genetic links. Research has uncovered that Crohn’s disease and type 1 diabetes are both linked to variations of two genes — PTPN2 and PTPN22.

Both of these genes are involved in intracellular signaling (communication between cells in the body). The PTPN22 gene is also involved in a host of other autoimmune and autoinflammatory conditions, such as lupus and rheumatoid arthritis.

Medication Interactions

Certain medications used to treat diabetes can affect Crohn’s symptoms. Likewise, some Crohn’s treatments can affect diabetes. Side effects of these treatments may make management of Crohn’s or diabetes more difficult. Always talk to your gastroenterologist if you’re concerned about your medication interactions or side effects.

Metformin

Metformin is a drug commonly used as a first-line treatment for type 2 diabetes. Metformin can have gastrointestinal side effects similar to Crohn’s symptoms, including nausea, vomiting, loss of appetite, and diarrhea. These side effects tend to occur when someone first starts metformin, then go away in a matter of weeks.

Despite the initial side effects, metformin may be a useful treatment for reducing inflammation and improving intestinal barrier dysfunction in IBD. Metformin can also lower the risk of people with type 2 diabetes developing IBD.

Corticosteroids

Corticosteroids are anti-inflammatory medications prescribed to control IBD flares and induce remission of Crohn’s disease. However, oral or injected corticosteroids can significantly raise blood sugar levels and, in some people, may lead to type 2 diabetes.

People with diabetes who take a course of corticosteroids need to watch their blood sugar carefully because steroids can raise blood sugar to dangerous levels. Fortunately, diabetes treatments such as insulin are effective for controlling this side effect of steroid therapy.

Corticosteroids also suppress the body’s immune response, increasing risk of infection, especially viral and fungal infections. Since diabetes already impairs the normal immune response, people with diabetes may be at a significantly higher risk of infection while on steroids.

Talk With Others Who Understand

MyCrohnsAndColitisTeam is the social network for people with Crohn’s disease and their loved ones. On MyCrohnsAndColitisTeam, more than 157,000 members come together to ask questions, give advice, and share their stories with others who understand life with Crohn’s.

Are you or is someone you care for living with Crohn’s and diabetes? Share your experience in the comments below, or start a conversation by posting on your Activities page.

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