If you’ve been following our journey for a while, you know that managing Type 1 diabetes often feels like putting together a puzzle. Most of us expect to think about carbohydrates, insulin, activity levels, illness, growth spurts, and hormones. Those are the things we’re taught can affect blood sugar. But one thing that isn’t talked about nearly enough is constipation, and how much of an impact it can have on diabetes management.
Unfortunately, constipation has become something we’ve had to think about again recently. For quite a while, Kay wasn’t struggling with it at all, so when it started happening again, I honestly didn’t think much of it at first. Then I started noticing a pattern. On the days she was constipated, her blood sugars often seemed much more difficult to manage.
Sometimes the reason for her constipation is pretty obvious. Maybe she hasn’t had quite enough water that day, or she’s eaten foods that tend to slow things down. Other times, there doesn’t seem to be any explanation at all. If you’ve ever dealt with constipation, you probably know what I mean. It almost feels like once it starts, it becomes much easier for it to happen again, even when you’re doing everything you can to prevent it.
Because Kay has Down syndrome, constipation is actually quite common. Low muscle tone doesn’t just affect the muscles we can see. It can also affect the muscles throughout the digestive tract, making it more difficult for food and waste to move through the intestines efficiently. Many individuals with Down syndrome experience constipation throughout their lives, so it’s something we always try to keep an eye on.
What surprised me, though, was learning how much constipation can influence blood sugars.
When someone is constipated, digestion often slows down. Food may stay in the stomach and intestines longer than expected, which means carbohydrates may not be absorbed when you expect them to be. You might give insulin for a meal, only to watch blood sugars stay fairly stable at first. Then, hours later, they suddenly begin climbing because the food is finally being digested and absorbed. It can make it seem like insulin isn’t working properly when, in reality, the timing between the insulin and the digestion is simply out of sync.
Constipation can also place stress on the body. When the body is under stress, it releases hormones that can make cells less responsive to insulin. This is called insulin resistance. It doesn’t mean insulin suddenly stops working. It simply means the body may require more insulin than usual to achieve the same effect.
For us, this can look like correction doses that don’t seem to bring Kay down as quickly as they normally would. Blood sugars may stay elevated longer than expected, or she may seem more resistant even though nothing else in her routine has changed. Those days can be incredibly frustrating because you start questioning everything. Did we count the carbs correctly? Is the pump site failing? Is she getting sick? Is she growing? Sometimes the answer is none of those things. Sometimes she’s simply constipated.
That doesn’t mean constipation is always the cause of insulin resistance. There are so many things that can affect blood sugars. Illness, hormones, stress, excitement, growth, medications, and even poor sleep can all play a role. But constipation is one of those possibilities that often gets overlooked, even though it can have a very real impact.
One thing I’ve learned over the past two years of managing Type 1 diabetes is that our Dexcom graph is often telling us a story. Sometimes we just have to figure out which chapter we’re in. I’ve found myself becoming a bit of a detective, looking at everything that could be contributing to what we’re seeing. If Kay’s blood sugars suddenly become stubborn for no obvious reason, one of the first questions I ask myself now is, “When was her last bowel movement?”
It’s funny because before diabetes, I never imagined I would spend so much time talking about blood sugars, insulin, bowel movements, hydration, and digestion all in the same conversation. But that’s the reality of living with a chronic condition. You start realizing how connected every system in the body really is.
Sometimes the biggest diabetes lessons come from the things we never expected to have anything to do with blood sugar at all.