How are diabetes and inflammatory bowel disease connected? Jennifer Okemah, our founder and clinical director, was invited to talk about the connection between diabetes and inflammatory bowel disease, as well as the treatments for both conditions.

Written by Jewels Doskicz.

Interviewee: Jennifer Okemah, MS, RDN, CSSD, BC-ADM, CDCES

If you have diabetes, you may be at higher risk for inflammatory bowel disease (IBD), an autoimmune condition that affects the gastrointestinal (GI) tract. While there is no cure, there are treatments and medications to improve everyday life for people with IBD and diabetes.

IBD affects roughly 1 in 100 people in the U.S. and causes a range of issues in the GI tract and other parts of the body. Moreover, people with diabetes are at an increased risk for bowel-related conditions, with up to 75 percent reporting gut issues such as diarrhea, constipation, and stomach pain.

Research is ongoing to better understand what triggers IBD attacks, and why they happen to some people and not others. When left untreated, tissue inflammation in the GI tract can be harmful to the body. That’s why it’s important to speak to a healthcare provider about any GI symptoms you may be having so they can help pinpoint the cause.

On the flip side, there is also an increased risk of developing diabetes in people who have IBD. Part of the risk is related to the use of steroids as a treatment for IBD. People with both type 1 and type 2 diabetes have been implicated in the increased risk of IBD.

What is IBD and what causes it?

“IBD is a lifelong, chronic inflammatory condition of the digestive tract with ulcerative colitis and Crohn’s disease being the two most common types,” said Jennifer Okemah, a certified diabetes care and education specialist and owner of Salute Nutrition, a diabetes and nutrition private practice in Washington state.

“While ulcerative colitis generally affects the large intestine, Crohn’s disease can affect the entire digestive tract (from mouth to anus). Both of these conditions can be very painful and have ongoing exacerbations,” said Okemah.

Although IBD can happen to anyone, studies suggest an increased risk of ulcerative colitis (UC) and Crohn’s disease in people living with diabetes.

Like other autoimmune conditions, the exact cause of IBD remains uncertain. There isn’t a single cause of IBD. Rather, studies show a combination of genetic, environmental, and immune system factors at play.

It’s thought that specific genes, plus environmental triggers, cause defects in the immune system. In turn, that begins an attack on the body’s healthy digestive system. This results in tissue inflammation and a variety of symptoms that can cause significant emotional and physical distress.

What are the symptoms of IBD?

Both UC and Crohn’s disease are different for different people. Symptoms may wax and wane, as well as their intensity, from minimal to severe. Both usually involve episodes of flares (worsening of symptoms) that may require taking corticosteroid medications for inflammation or switching to a new IBD medication.

Common symptoms of IBD may include:

  • Diarrhea or constipation
  • Bloody stools
  • Mucous or pus
  • Abdominal cramping
  • Abdominal pain and bloating
  • Malnutrition
  • Malabsorption or weight loss

With IBD, people will often develop “extra-intestinal” symptoms. In other words, it’s common to have symptoms and conditions that aren’t gut-related throughout the body.

Extra-intestinal symptoms of IBD may include:

  • Fever
  • Exhaustion
  • Depression and anxiety (the “feel-good” hormone serotonin is produced in a healthy gut)
  • Skin rashes and mouth sores
  • Joint pain
  • Eye issues
  • Hair loss

How is IBD treated?

IBD is unique to each individual, so the treatments are, too. There are a variety of medications that can help to treat IBD symptoms, decrease inflammation, and temper the immune system. While people often start on drug therapies, they may also try alternatives for stress reduction (like yoga, meditation, and exercise), acupuncture, and other complementary therapies.

It can take some time to refine treatments to support remission. That’s why building a support team for personalized care is so important. Having a registered dietitian with broad IBD knowledge, as well as professional support for your emotional well-being, is key to living your best life with IBD.

How do I know if I have UC or Crohn’s?

If you’re having bothersome GI symptoms, it’s never too early to seek care from your primary care provider. They’ll do a physical exam, order testing, and likely refer you to a gastroenterologist (an expert in the digestive system).

“Receiving a diagnosis is vital in providing targeted therapy for someone’s condition,” said Okemah. “And it’s a fairly straightforward process with blood and stool testing, imaging, or endoscopy procedures.”

While the prep for an endoscopy procedure isn’t something anyone looks forward to, it’s important to find out exactly what’s going on. Preventative colonoscopy screening recommendations begin at age 45, so even if you don’t have GI issues, it’s important to schedule an appointment.

Diabetes and other gastrointestinal conditions

“With diabetes, there can be a lot of dysbiosis – or an imbalance in good and bad gut bacteria,” explained Okemah. “I want to know if someone is consuming high levels of sugar alcohols, erythritol, and mannitols, which can be a common source of gut issues with diabetes.”

“As a registered dietitian, I work backward to discover what’s going on with a person’s intake and identifying what can be gut-disruptive. What may seem like a mystery can be peeled away quicker than you would think,” said Okemah.

IBD isn’t to be confused with other GI conditions such as:

  • Irritable bowel syndrome (IBS)
  • Celiac disease
  • Gastroparesis
  • Small intestine bacterial overgrowth
  • Small intestine fungal overgrowth
  • Exocrine pancreatic insufficiency
  • Chronic pancreatitis
  • Non-alcoholic fatty liver disease (NAFLD)

How do food choices affect gut health?

“With diabetes, there are a lot of mixed dietary messages coming in, which is unfortunate,” said Okemah. “And while certain foods may worsen IBD symptoms, they do not cause IBD.”

Okemah explained that it’s common for people to self-treat GI conditions before seeking help. A good example is switching to a gluten-free diet, which they may not need. Unless it’s medically necessary like in the case of celiac disease, going gluten-free isn’t the best choice for diabetes as many foods have been stripped of fiber.

“As registered dietitians, we start building a diet of what people ‘can’ eat and focus on what’s working. Our goal is to reintroduce healthy anti-inflammatory foods and widen diets so people with IBD can eat foods they once enjoyed,” said Okemah.

If you’re wondering what’s one easy thing you can do to improve your gut health, Okemah suggested eating more prebiotic foods. Easy to find at your local grocery store, prebiotic foods offer protective benefits to the gut and are found in miso, kimchi, pickles, sauerkraut, and ciders – to name a few.

When should I see a healthcare provider?

“It can be a confusing time when someone isn’t feeling well and they don’t know what to do, but there needs to be a diagnosis,” said Okemah. “While it may be a natural inclination to go to Dr. Google and self-diagnose, GI issues necessitate a trip to the doctor, and likely, a scope.”

“Diabetes already has its set of difficulties, and if you’re dealing with a digestive disorder on top of that, we need to know exactly what it is. Then we can work on a methodical and systematic plan of attack, so you know what your gut can handle and start to feel better,” said Okemah.

There’s no need to suffer in silence. While GI symptoms may feel embarrassing to discuss at first, your health is a priority. So don’t wait, speak up, and make an appointment with your provider today.

“When I see new diabetes technology, I ask myself, ‘Where does it shine?’” said Jennifer Okemah, MS, RD, BCADM, CDCES, CSSD, from Salute Nutrition near Seattle, WA.

She admits she was skeptical of the CeQur Simplicity insulin patch at first.

“I quickly realized the shine of this insulin patch technology is how basic it is,” said Okemah.

Worn on your abdomen for up to three days, this ultra-thin patch requires just an easy squeeze of two small buttons to deliver insulin in 2-unit increments.

“When I show this insulin patch to my patients, their first reaction is usually, ‘Really? All I have to do is squeeze the buttons to take my insulin? That’s it?’” Okemah explained.

“It’s about simplicity. There are so many high-tech diabetes options out there, but the simplicity of this insulin patch is exactly what many people want.”


For people with any type of diabetes who don’t like taking injections in public, the discretion of squeezing buttons to dose insulin can be a true game-changer. You can even squeeze those buttons through the fabric of your shirt. With its super thin profile, this patch is probably the most discreet insulin-delivery system on the market.

Okemah said she realized that this patch technology could serve a remarkable number of her patients with type 1 and type 2 diabetes who were missing mealtime insulin doses via injection.

Reasons you might miss mealtime insulin doses include:

  • Not comfortable taking injections in public
  • Aren’t able to easily keep an insulin pen with you
  • Don’t like having to carry an insulin pen with you
  • Have a hard time remembering to take your insulin

“If you need help taking your mealtime insulin for whatever reason, CeQur could work for you,” said Okemah.


Read more>>

1. The reason your blood sugar is high in the morning is because of what you ate for dinner the previous night.

There are many reasons why blood sugar can be elevated in the morning and food is only one reason. During the night or during long periods of not eating, your liver makes glucose for your body so it has consistent fuel available. This is true for everyone, whether they have diabetes or not. As your blood sugar rises, the pancreas matches it with trickles of insulin to keep levels steady. But this changes in pre-diabetes and then throughout the progression of diabetes. Rather than producing steady levels of insulin, the cells in the pancreas that make insulin slowly die out (type 2 diabetes). This progression can be evident by slowly rising blood sugars in the morning.

2. I can’t eat carbs.

The human body will make glucose out of any food you eat if it has to. But to produce energy, it prefers using carbohydrates. Eating smaller amounts of high-quality carbs helps provide the right fuel for the body thereby allowing the protein to repair tissue and fat to transport molecules such as vitamins and hormones. On the flip side, eating zero carbs is not sustainable or even possible. Remember – it’s best to eat high-quality carbs like whole-wheat pasta or bread, brown rice, green vegetables, flaxseed, beans, lentils, etc., and not processed carbs like sugar and processed packaged foods.

3. My metformin stopped working.

Metformin is oftentimes one of the first medications used after and in conjunction with education and nutrition therapy for diabetes management. Metformin targets the liver to help it make less glucose so that fasting blood sugars are more manageable, but it does not work on elevated blood sugar related to food. Because Type 2 diabetes is a progressive disease Metformin may work for years. And then it may seem like it’s not doing its job. That’s because as diabetes progresses, which it will, your HbA1C will elevate and when it does, it’s time to come up with a new plan and try other drugs.

4. It’s better to have real sodas like Coke than diet sodas.

The truth is that the human body does not need ANY soda in any form whether regular or diet. There is nothing healthy about any soda option. Pure sugar that’s found in soda directly raises blood sugar and repetitively challenges the pancreas to make extra insulin that the body doesn’t need. The rise of insulin causes the body to store calories. Diet sodas don’t do this because artificial sweeteners don’t raise blood sugar, but they are not a healthy choice for other reasons. Caffeine, found in most of these drinks, can raise blood sugar too. Bottom line? Humans need water, not Coke Zero.

5. Adults with diabetes have type 2. Children with diabetes have type 1. 

 Adults and children both can get type 1diabetes. Type 1 is an autoimmune disease in which the person’s immune system has attacked and killed all of the beta cells in the pancreas. These are the cells responsible for making insulin. Humans need insulin just like they need oxygen. So they have to inject it to create energy from food. Likewise, adults and even teenagers and younger can get type 2 diabetes, which is not an autoimmune disease. In type 2, the body overproduces insulin from the same beta cells on the pancreas which affects type 1. However, the process is slow and difficult to catch. Whereas type 1 is sudden and definitive to diagnose. One disease does not turn into the other because they are separate and different.


Skipping routine A1c tests because of the ongoing COVID-19 pandemic and telehealth appointments have left many people with diabetes with rising blood sugars and too little support.

The sharp drop in A1c testing over the last year during the ongoing pandemic and a rocky transition to virtual healthcare has left many people with diabetes with rising blood sugars and too little support.

Depending on the resources where you live, getting an A1c test prior to a telehealth appointment with your doctor came with many potential obstacles such as:

The labs in your area were closed.
Open labs are not within reasonable distance from your home.
Your healthcare team had no system in place to order labs under these circumstances.
Doctors working from home had no way to send referrals from home computers.
Doctors working from home were unable to access their usual appointment process.
You were afraid to go get blood work done due to the pandemic.
You didn’t want to sit in your car and wait to be called into the lab.
You were reluctant to go somewhere new for lab work.
You were given a referral to get blood work done but decided not to go.

“75 percent of our patients are still choosing telehealth appointments,” says Jennifer Okemah, MS, RD, BCADM, CDCES, CSSD, from Salute Nutrition near Seattle, WA. Okemah and her team work with people with diabetes from all over Washington state.

Fortunately, Okemah and her team were well-prepared for virtual healthcare, because it had been part of their clinic prior to the pandemic with clients spread across the state and only 4 physical offices.

However, the patient referrals Okemah normally receives from other primary care and endocrinology offices revealed just how significant the lack of A1c testing was for patients in other clinics, and the inability to send referrals at all during stay-at-home orders.

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Editor’s Note: This article is about Ginger’s personal experience using Afrezza, and what has worked for her may not work for everyone. Please consult your healthcare team before making any changes to your diabetes care regimen. Beyond Type 1 has an active partnership with MannKind, makers of Afrezza. This article was not produced as part of that partnership, and the company had no input into its creation.

I’ve lived with type 1 diabetes for over 23 years. Using long-acting and rapid-acting insulins (and one decade on an insulin pump), I’ve taken approximately 45,000 injections. After years of hearing friends in the diabetes community talk about using inhaled insulin, I finally gave it my full attention over the last month.

Here, I share as much detail as possible about my experience using Afrezza inhaled insulin for my mealtime and correction doses of insulin.

It’s wicked fast — faster than I thought possible. I never dose until I’m done eating.
It makes preventing lows around exercise so much easier.
Once you learn how to dose it, the mild lows nearly correct themselves because it clears your system so quickly.
When correcting mild-to-severely high blood sugars, you’re in your goal range within 30 to 60 minutes because it’s so fast.
You don’t get the food cravings that come with injected rapid-acting insulin!
It’s amazingly fun to take insulin without stabbing my body multiple times a day with a syringe!

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