Lesser Known Type 2 Diabetes Complication

Gallstones and type 2 diabetes
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When people talk about type 2 diabetes complications, the ones that usually come to mind are those affecting vision (diabetic retinopathy), the nerves (diabetic neuropathy), and the kidneys (diabetic nephropathy). Many people with type 2 diabetes, however, don’t hear much about a lesser known complication: gallstones.

What are gallstones?
Gallstones are hard stone-like formations that can range in size from a grain of sand to a ping pong ball. Approximately 20 million adults in the United States have gallstones, and each year 1 to 3 percent of US adults are diagnosed with the condition.

The stones are usually composed of cholesterol or bilirubin, a waste product of a substance (bile) that is produced by the gallbladder. When the concentration of one of these substances becomes too high, one or more stones can form.

Why do people with type 2 diabetes get gallstones? Experts are not certain but they have several theories.

  • Presence of a combination of factors, including insulin resistance, high triglycerides, and obesity, which are risk factors for the stones
  • Autonomic neuropathy, a type of diabetic neuropathy that can damage nerves that control the gallbladder
  • Presence of a protein (FOXO1) that is associated with diabetes and which causes a rise in the amount of cholesterol in bile

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The best way to prevent gallstones is to adequately control your blood glucose and triglyceride levels and maintain a healthy weight. If you do develop gallstones, there is also a good chance they will not cause any symptoms and so no treatment is required.

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However, if the stones do cause symptoms, they can include

  • Sudden pain that develops in the right upper abdomen, typically after eating a fatty meal. The pain can last for several hours
  • Right-sided abdominal pain that worsens after eating
  • Pain under the right shoulder or between your shoulder blades
  • Unexplained nausea or vomiting

Why it’s important to prevent gallstones
Naturally, no one wants to have gallstones. However, if you have type 2 diabetes, there are a few special reasons why you should want to prevent these stones from forming.

One is that people with diabetes are usually at a greater risk for complications associated with surgery, and that includes gallbladder removal. Although not everyone who has gallstones needs surgery, if the stones become problematic the gallbladder usually needs to be removed.

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Another reason can be found in a new study in the European Journal of Preventive Cardiology, where the authors point out that people who develop gallstones are at an increased risk of cardiovascular events.

Type 2 diabetes is associated with a variety of complications, and one that often is forgotten is gallstones. The good news is that careful attention to management of your glucose levels and other risk factors can help you prevent development of gallstones and other complications of diabetes as well.

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REFERENCES
Emedicine/Medscape
Wirth J et al. Presence of gallstones and the risk of cardiovascular diseases: The EPIC-Germany cohort study. European Journal of Preventive Cardiology 2013 Oct 31. Epub ahead of print

Image: Wikimedia Commons

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