With type 1 or type 2 diabetes, you have high blood glucose levels because of your body’s inability to properly produce or use the hormone insulin. Ulcerative colitis comes from an inflammation of the lining of the cells in the large intestine or rectum. But drugs like steroids, which are used to treat symptoms of ulcerative colitis, such as diarrhea, stomach pain, and inflammation, can raise blood glucose levels. Steroids can also cause people who aren’t prone to having high blood sugar to develop diabetes, according to research published in July 2015 in the World Journal of Diabetes. And the health risks of steroid use don’t end there. A study published in December 2020 in PLOS Medicine found that steroid use to reduce inflammation in people with diseases such as IBD increases the risk of cardiovascular disease. RELATED: The Pros and Cons of Taking Steroids for Ulcerative Colitis If you’re taking steroids for ulcerative colitis symptoms, experts like Sacha Uelmen, RDN, CDCES, the director of diabetes education and prevention programs at the Association of Diabetes Care & Education Specialists, recommends using insulin to keep your blood sugar levels in check. “Work with an endocrinologist to figure out how much insulin is needed, and keep a close eye on your blood sugar,” Uelmen says. “Once you’ve gotten the flare under control, your doctor will likely taper off the insulin, just as your gastroenterologist will taper off the steroids.” Depending on your situation, the endocrinologist or your primary care provider may use oral medications, such as metformin, instead of insulin.
How Diabetes Medications Affect Ulcerative Colitis
For people with ulcerative colitis, diabetes medications like metformin can sometimes cause unpleasant side effects, such as more frequent bowel movements, diarrhea, nausea, and abdominal pain — symptoms similar to ulcerative colitis. Moreover, eating a high-fiber diet, which is often recommended for people with diabetes, can trigger colitis flares. When that occurs, Uelmen suggests focusing on treating the flare first. “Ulcerative colitis is more important to treat than diabetes because the symptoms are in a temporary phase,” she says. “Once you’re able to calm down the flare, you can switch back to eating more fiber.” But be sure to follow recommendations from your doctor regarding which condition to treat first.
The 2 Conditions May Affect Each Other on a Cellular Level
Whether one condition makes you more prone to getting the other remains unclear, but some research suggests that may be the case. A study published in August 2019 in the journal Clinical Gastroenterology and Hepatology found that chronic intestinal inflammation from an IBD may increase the risk of type 2 diabetes. This nationwide population-based study included more than 6 million people in Denmark. To estimate diabetes risk, the researchers compared data from people diagnosed with IBD with data from those in the general population from 1977 to 2014. They found the highest risk to be from 2003 to 2014, compared with earlier years in the study period, leading the authors to call for more research looking at the effects of IBD treatment on the risk of type 2 diabetes. There’s also evidence to suggest that type 1 diabetes and ulcerative colitis share some genetic characteristics. Research published in the World Journal of Gastroenterology found that in both diseases, genetic and environmental factors contribute to uncontrolled immune function — when the immune system mistakenly attacks what it thinks are foreign “invader” cells and initiates an inflammatory response to protect the body. This mechanism ultimately affects how the body produces insulin (by attacking the beta cells in the pancreas that produce insulin) or how it protects the lining of the intestine. Researchers also found that the diseases had similar complications, including nerve damage, venous thrombosis (which occurs when a blood clot forms deep in the vein), and bone loss. “Research in the last 10 years has transformed genetic knowledge of these diseases,” says Hakon Hakonarson, MD, PhD, the director of the Children’s Hospital of Philadelphia Center for Applied Genomics at the Joseph Stokes Jr. Research Institute. “The goal now is to develop new therapies that focus on underlying genetic causes and specific mutations found in certain individuals,” Dr. Hakonarson says, “so we don’t have to use therapies like steroids [for colitis], which only treat the symptoms.” But such treatments are likely years away from coming to market.
Strategies for Managing Your Ulcerative Colitis and Diabetes
In the meantime, taking prescribed medications and avoiding certain foods that aggravate ulcerative colitis symptoms is the best course of action. Here are some other ways you can treat and manage both diabetes and colitis.
Eat smaller meals.Limit your intake of foods with soluble fiber and avoid greasy or fried foods.Work with your doctor to find drugs other than steroids that won’t affect your blood sugar levels. Examples include sulfasalazine or immunosuppressants like Prograf (tacrolimus), or Imuran (azathioprine), or biologics such as Remicade (infliximab) or Humira (adalimumab).If you have type 2 diabetes, consider oral drugs that stimulate insulin release or increase insulin action, such as sulfonylureas like Glipizide or GLP-1 agonists like exenatide (Byetta), all of which have the fewest side effects. Metformin is also effective and is commonly used. It comes in an extended-release version that can decrease your risk of side effects.Get support. “Work with a team, along with a dietitian, who can help you address all the complications that can come up,” says Uelman.Maintain blood sugar control, because this reduces the frequency and severity of complications. You may need self-injections of insulin and finger-stick blood sugar testing.
Additional reporting by Linda Thrasybule and Ashley Welch.
