Does constipation cause high blood sugar? ======================================= The relationship between the digestive system and blood sugar Regulating the blood sugar level is one of the most important physiological processes in the body and any disturbance in this field can lead to the occurrence of diseases such as type 2 diabetes. Many people think that only the pancreas and insulin are involved in this process, but the fact is that the digestive system, especially the intestines, play a key role in the absorption and metabolism of sugar. ### The role of intestines in glucose absorption: The digestive system, especially the small intestine, plays an essential role in the absorption of glucose from food. After digesting carbohydrates, glucose molecules in the small intestine are absorbed by the lining cells and enter the bloodstream. The speed and quality of this absorption is affected by several factors such as the type of food (its glycemic index), the amount of fiber consumed, the health of the intestinal mucosa, and the motor function of the digestive system. Disorders such as constipation, irritable bowel syndrome or intestinal inflammations can disrupt this process and lead to blood sugar fluctuations. Therefore, the proper functioning of the intestines plays a key role in preventing unexpected highs or lows in blood sugar. ### The effect of digestive health on sugar metabolism: The health of the digestive system is not only limited to the mechanical function of digestion and absorption of food, but also directly plays a role in the regulation of sugar metabolism. Incretin hormones secreted from intestinal cells – especially GLP-1 and GIP – have a significant effect on blood sugar. By stimulating the secretion of insulin, reducing the secretion of glucagon and slowing down gastric emptying, these hormones cause better control of blood sugar and create a feeling of satiety. In people with type 2 diabetes, the function of these hormones is usually impaired or impaired. Also, disorders such as slowness of stomach movements (gastroparesis) or chronic constipation, change the time and manner of glucose absorption and make it difficult to regulate blood sugar levels. Therefore, the health of the digestive function has a direct and profound effect on the control of sugar metabolism. ### Intestinal microbiome relationship with diabetes: The gut microbiome – the collection of billions of beneficial bacteria and microorganisms living in the gut – has been recognized in recent years as an important factor in metabolic health. Several studies have shown that an imbalance in the composition of these microorganisms (a condition called dysbiosis) can lead to increased intestinal permeability, chronic inflammation, and disruption of the body's response to insulin. In diabetics, microbial diversity is usually lower than normal and the presence of some beneficial bacteria such as *Akkermansia muciniphila*, which play a role in blood sugar control, is reduced. On the other hand, some harmful bacterial species may produce certain toxins that interfere with insulin action. For this reason, strengthening the gut microbiome through diet, consumption of probiotics and prebiotics can be considered as an effective strategy for better blood sugar control. ### New drugs and methods in controlling obesity and diabetes: In the last decade, medical science has adopted a new approach to controlling diabetes and obesity, which focuses on directly affecting the digestive system and regulating gut hormones. One of the most successful treatments in this field is the use of GLP-1 agonist drugs such as semaglutide (Ozempic, Wegovy) and liraglutide (Victoza, Saxenda). By mimicking the natural function of the GLP-1 hormone, these drugs reduce appetite, increase insulin secretion, lower blood sugar and, in many cases, significant weight loss. Also, metabolic surgeries such as gastric bypass, in addition to reducing the volume of the stomach, change the digestive hormonal structure in such a way that diabetic patients may even control their blood sugar without medication. On the other hand, probiotics and prebiotics with the aim of restoring the balance of the gut microbiome can have beneficial effects in regulating blood sugar. Also, drugs such as SGLT2 inhibitors that increase the excretion of glucose through the urine or alpha-glucosidase inhibitors that slow down the absorption of glucose in the intestine are all part of the targeted gastrointestinal therapies in the control of diabetes. Can constipation cause high blood sugar? One of the important questions that occupy the minds of many diabetic patients or people with digestive problems is **Can constipation directly or indirectly cause an increase in blood sugar?** At first glance, there may not seem to be a connection between intestinal function and blood glucose levels, but with a closer look at the body's mechanisms and the complex interaction between digestion, hormones and metabolism, it is clear that this hypothesis can have a scientific basis. Although extensive research is still underway, preliminary evidence and clinical studies have shown that constipation, especially if left chronic and untreated, can negatively affect blood sugar. Possible mechanisms of the effect of constipation on blood sugar Constipation, as a disorder of normal bowel movements, can affect blood sugar levels by causing changes in nutrient absorption, gut microbiome function, and gastrointestinal hormone system. One of the important mechanisms is the reduction of intestinal movement (motility). In the condition of constipation, the passage of food through the intestines is delayed and this issue can increase the duration of food contact with the absorption surface of the intestine. As a result, glucose absorption may increase or its temporal pattern may change, which can cause fluctuations in blood sugar levels, especially in people with type 2 diabetes. On the other hand, chronic constipation is also associated with changes in the composition of the gut microbiome. These changes can increase chronic inflammations, reduce insulin sensitivity and disrupt the functioning of intestinal hormones. For example, a decrease in bacteria producing short-chain fatty acids (such as butyrate), which play a role in blood sugar regulation, has been observed in patients with constipation. These factors can put the body in a state of "metabolic stress" that leads to an increase in blood sugar. Also, in the condition of constipation, the possibility of reabsorption of toxic or partially digested substances from the intestinal wall increases, which can disrupt the inflammatory and hormonal responses of the body. Can delayed excretion increase glucose absorption? One of the key questions in investigating the relationship between constipation and blood sugar is: Can delayed excretion lead to increased glucose absorption? The answer to this question depends on the type and degree of constipation, diet and general health status of the person. But scientifically, when food stays in the gut longer, especially in the small intestine and the beginning of the large intestine, there is more opportunity for glucose and other nutrients to be absorbed. This can cause high blood sugar levels in some people, especially those who are prone to diabetes. Also, the delay in bowel emptying may cause some foods that are usually excreted faster to be more affected by digestive enzymes and convert them into glucose or simple sugars with higher efficiency. This issue is especially important when consuming foods with high carbohydrates. On the other hand, decreased bowel movements may also affect the timing of insulin secretion and other glucose-related hormones. Simply put, the body expects glucose to enter the blood at a certain time, but due to constipation, this time is changed and the body is not prepared enough to control glucose. Why are diabetic patients more constipated? Constipation is one of the common problems among patients with diabetes, so that studies show that between 20 and 60 percent of diabetic patients experience some degree of digestive disorders, especially constipation. But why does this happen? One of the main causes is nerve damage caused by high blood sugar (diabetic neuropathy). This nerve damage, which can involve the nerves that control the movements of the digestive system, causes a decrease in normal bowel movements (peristalsis). As a result, waste materials move slowly through the digestive tract, leading to constipation. Also, reducing the level of physical activity, controlled but low-fiber diets, the use of diabetes-specific drugs such as SGLT2 inhibitor drugs or even insulin, as well as the reduction of body water due to excessive excretion of urine (diabetic hyperuria), are all factors that can aggravate constipation in diabetic patients. In more advanced cases, some patients are less inclined to follow healthy eating habits and physical activity due to psychological problems, chronic anxiety or depression caused by diabetes, which also aggravates constipation. Effect of constipation on blood sugar control in diabetic patients Constipation is not only an annoying physical discomfort, but in diabetic patients, it can face serious challenges in the blood sugar control process. When gut motility slows down, the absorption of glucose from food is rescheduled and sometimes increased, making it harder to predict the body's response to meals. For example, the patient may expect the blood sugar level to rise immediately after a meal and take insulin or medicine accordingly, but with a delay in glucose absorption, the blood sugar rises suddenly and later, and it becomes difficult to accurately regulate it. On the other hand, constipation can increase the level of internal inflammation and reduce insulin sensitivity. Changes in the gut microbiome, which is more common in diabetic patients with constipation, can reduce the production of certain anti-inflammatory substances such as short-chain fatty acids and disrupt sugar metabolism. Also, if a patient feels heavy, nauseous, or bloated due to chronic constipation, they may delay or reduce their intake of food, medication, and even insulin, which in turn leads to extreme fluctuations in blood sugar. Challenges of simultaneity of these two diseases At the same time, diabetes and constipation create multi-layered challenges for the patient. On the one hand, the patient must follow a diet that both controls blood sugar and increases fiber and prevents constipation; While common diabetic diets usually limit consumption of white bread, rice, high sugar or high fiber fruits. On the other hand, common treatments for constipation, such as laxatives or insoluble fibers, may not be suitable for a diabetic patient or cause bloating and fluctuations in blood sugar. In addition, the simultaneous control of two diseases requires more complex drug, food and behavioral coordination. The patient may have to take more medications, which increases the likelihood of drug interactions, reduced compliance, and mental fatigue. Also, the presence of uncomfortable symptoms of constipation such as abdominal pain, loss of appetite or nausea can reduce the patient's motivation to follow a regular diet and medication plan. In acute conditions, chronic constipation may lead to complications such as intestinal obstruction, hemorrhoids, or even hypoglycemia due to delayed absorption of food. For this reason, the control of constipation in diabetic patients should be considered not only for the patient's convenience, but also as a serious part of the overall management of diabetes. A close collaboration between the physician, nutritionist, and patient can help reduce these challenges. If a person is experiencing chronic constipation, especially if it is accompanied by dangerous symptoms or blood sugar fluctuations, the condition should not be ignored. Visiting a doctor for specialized examinations and finding the exact cause of this problem is the best way to prevent more serious complications. Timely diagnosis can play a big role in controlling diabetes, gut health and improving quality of life. **To receive a visit (online or in person) with Dr. Yazdan Panah, fill out the form below**