ISLAMABAD: No one wants to talk about diarrhoea. More so, no one wants to experience it. Unfortunately, diarrhoea is often the body’s natural way of expelling waste in liquid form when a bacterial or viral infection or parasite is present. However, there are other things that can cause diarrhoea for everyone, and some things that can cause diarrhoea specifically in those with diabetes. There are various things that can cause diarrhoea. These include: Illness, such as bacterial or viral infection, or food poisoning. Large amounts of sugar alcohols, such as sorbitol, that are often used in sugar-free products, taking lactose (milk sugar) when someone is lactose intolerant. Some medications, such as metformin, a common medication used to treat diabetes. Diseases such as irritable bowel syndrome, Crohn’s disease, and celiac disease. Autonomic neuropathy, a long-term complication of diabetes In some cases, such as with illness or the use of sugar alcohols, diarrhoea does not last for long. It tends to stop once the illness is over or the person stops using sugar alcohols. Diarrhoea can be caused by many things, including a diabetes medication called metformin. With metformin, the symptoms can go away with time. Some people in whom the diarrhoea does not resolve may need to stop taking the medication, however. Bowel diseases may cause lasting problems for people with these conditions. Diarrhoea and other symptoms can be managed or controlled with lifestyle changes such as stress reduction, and medications as needed. People with type 1 diabetes are at higher risk of celiac disease, and should check for this if long-term diarrhoea is a problem for them. A long-term complication associated with diabetes that can lead to long-term diarrhoea (and constipation) is called autonomic neuropathy. Autonomic neuropathy occurs when there is damage to the nerves that control how the body works. Autonomic neuropathy can affect the nerves that control all automatic bodily functions such as heart rate, sweating, and bowel function. Since diabetes is the most common cause of autonomic neuropathy, people with long-term diabetes complications struggle with the effects the disease has on their nervous system. Reports show as many as 75 percent of patients visiting diabetes clinics will report significant symptoms affecting the gut. Diabetes can affect the entire gut, from the mouth to the anus. As a result, it’s no wonder that people with diabetes can report higher instances of diarrhoea.