Stomach pain in type 2 diabetes can arise from various causes, ranging from medication side effects to serious complications requiring urgent attention. Whilst type 2 diabetes itself does not directly cause abdominal discomfort, the condition can contribute to gastrointestinal complications such as diabetic neuropathy, gastroparesis, and medication-related symptoms. Understanding the potential connections between diabetes and stomach pain is essential for appropriate investigation and management. This article explores common causes, medication-related issues, warning signs requiring medical attention, and practical strategies for managing and preventing abdominal discomfort in people living with type 2 diabetes.

Understanding Stomach Pain in Type 2 Diabetes

Stomach pain is a complaint reported by some people living with type 2 diabetes, though the relationship between the two conditions is multifaceted and not always straightforward. Whilst type 2 diabetes itself does not directly cause abdominal pain, the condition can contribute to various gastrointestinal complications that may result in discomfort. Understanding the potential connections is essential for both patients and healthcare professionals to ensure appropriate investigation and management.

The gastrointestinal tract contains an extensive network of nerves and blood vessels, both of which can be affected by prolonged periods of elevated blood glucose levels. Diabetic neuropathy, which affects the autonomic nervous system, can disrupt normal digestive function and lead to a range of symptoms including abdominal pain, bloating, and altered bowel habits. Additionally, people with type 2 diabetes may experience stomach pain related to medications used to manage their condition, concurrent gastrointestinal disorders, or complications arising from poor glycaemic control.

It is important to recognise that stomach pain in someone with type 2 diabetes should not automatically be attributed to their diabetes. Many causes of abdominal discomfort are unrelated to diabetes and may include common conditions such as gastritis, peptic ulcer disease, gallstones, or irritable bowel syndrome. Upper abdominal or epigastric pain may occasionally represent cardiac ischaemia, particularly in people with diabetes who may experience atypical presentations of heart disease. A thorough clinical assessment is necessary to identify the underlying cause and ensure that serious conditions are not overlooked. Patients experiencing new, persistent, or severe abdominal pain—especially if accompanied by breathlessness, sweating, or chest discomfort—should seek medical advice promptly to allow for appropriate investigation and timely intervention.

Further information: NHS (Stomach ache and abdominal pain), NICE NG28 (Type 2 diabetes in adults: management), Diabetes UK (Diabetic neuropathy).

Common Causes of Abdominal Discomfort in Diabetic Patients

People with type 2 diabetes may experience abdominal pain from a variety of causes, some directly related to their metabolic condition and others coincidental. Diabetic ketoacidosis (DKA), whilst more common in type 1 diabetes, can occasionally occur in type 2 diabetes, particularly during periods of acute illness or severe metabolic stress. DKA typically presents with abdominal pain alongside nausea, vomiting, rapid breathing, and confusion, and requires urgent medical attention. Importantly, people taking SGLT2 inhibitors (such as dapagliflozin, empagliflozin, or canagliflozin) may develop euglycaemic DKA—a serious condition in which ketoacidosis occurs with blood glucose levels that are normal or only mildly elevated. If you experience abdominal pain, nausea, vomiting, breathlessness, or feel generally unwell whilst taking an SGLT2 inhibitor, seek urgent medical help even if your blood glucose is not very high.

Pancreatitis represents another important consideration, as people with type 2 diabetes have an increased risk of developing this painful inflammatory condition. The association may be related to shared risk factors such as obesity and hypertriglyceridaemia. Acute pancreatitis typically causes severe, constant upper abdominal pain that may radiate to the back, often accompanied by nausea and vomiting. Cases of pancreatitis have been reported in patients taking GLP-1 receptor agonists (such as exenatide, liraglutide, dulaglutide, and semaglutide); if you develop severe, persistent abdominal pain whilst taking one of these medications, stop the drug and seek urgent medical assessment. Additionally, GLP-1 receptor agonists have been associated with gallbladder and biliary disease, which can cause right upper quadrant pain and jaundice.

Constipation is frequently reported by people with diabetes and can cause significant abdominal discomfort, bloating, and cramping. This may result from autonomic neuropathy affecting bowel motility, inadequate fluid intake, certain medications, or reduced physical activity. Conversely, some individuals experience diarrhoea, which may be related to diabetic autonomic neuropathy, dietary factors, or medications such as metformin.

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in people with type 2 diabetes and, whilst often asymptomatic, can occasionally cause right upper quadrant discomfort. Additionally, people with diabetes are not immune to common gastrointestinal conditions affecting the general population, including gastro-oesophageal reflux disease, peptic ulcers, and functional dyspepsia, all of which may contribute to abdominal symptoms.

Further information: MHRA Drug Safety Update (SGLT2 inhibitors and risk of diabetic ketoacidosis), MHRA/EMC Summary of Product Characteristics for GLP-1 receptor agonists, NHS (Pancreatitis, Diabetic ketoacidosis).

When Diabetes Medications May Cause Stomach Pain

Gastrointestinal side effects are amongst the most commonly reported adverse reactions to diabetes medications, and understanding which drugs may cause stomach pain is important for both patients and prescribers. Metformin, the first-line treatment for type 2 diabetes recommended by NICE, frequently causes gastrointestinal symptoms, particularly when treatment is initiated or the dose is increased. These may include nausea, abdominal pain, bloating, and diarrhoea. Taking metformin with or after food and using gradual dose titration can help reduce these effects. The modified-release formulation of metformin is often better tolerated and may be considered for patients experiencing troublesome gastrointestinal side effects with standard-release preparations.

GLP-1 receptor agonists (such as exenatide, liraglutide, dulaglutide, and semaglutide) commonly cause nausea, vomiting, and abdominal discomfort, particularly during the initial weeks of treatment. These medications work by slowing gastric emptying and enhancing satiety, which can contribute to feelings of fullness and abdominal discomfort. Gradual dose titration, as recommended in the prescribing information, can help minimise these effects. Cases of acute pancreatitis have been reported with GLP-1 receptor agonists; if you develop severe, persistent abdominal pain, stop the medication and seek urgent medical assessment. GLP-1 receptor agonists have also been associated with gallbladder and biliary disease; seek medical advice if you experience right upper quadrant pain, jaundice (yellowing of the skin or eyes), pale stools, or dark urine.

SGLT2 inhibitors (such as dapagliflozin, empagliflozin, and canagliflozin) are generally well tolerated from a gastrointestinal perspective, though some patients may experience mild abdominal discomfort. Importantly, SGLT2 inhibitors carry a risk of diabetic ketoacidosis, including euglycaemic DKA (where blood glucose may be normal or only mildly elevated). If you experience abdominal pain, nausea, vomiting, breathlessness, or feel generally unwell whilst taking an SGLT2 inhibitor, seek urgent medical help. Alpha-glucosidase inhibitors (such as acarbose), which are less commonly prescribed in the UK, frequently cause flatulence, bloating, and abdominal pain due to their mechanism of action in the intestine.

Patients experiencing persistent or severe abdominal pain following initiation of a new diabetes medication should contact their GP or diabetes specialist nurse. In many cases, symptoms improve with continued use, but alternative treatment options may need to be considered if side effects remain troublesome or significantly impact quality of life. If you suspect a side effect from any medication, you can report it via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Further information: NICE NG28 (Type 2 diabetes in adults: management), MHRA/EMC Summary of Product Characteristics for metformin, GLP-1 receptor agonists, and SGLT2 inhibitors, MHRA Drug Safety Update (SGLT2 inhibitors and risk of diabetic ketoacidosis).

Gastroparesis and Digestive Complications in Type 2 Diabetes

Gastroparesis, or delayed gastric emptying, is a significant complication of diabetes that can cause considerable abdominal discomfort and impact both quality of life and glycaemic control. This condition results from damage to the vagus nerve (diabetic autonomic neuropathy), which normally coordinates the muscular contractions that move food through the digestive tract. When the stomach empties too slowly, patients may experience a range of symptoms including upper abdominal pain, bloating, early satiety, nausea, and vomiting.

The prevalence of gastroparesis in type 2 diabetes is difficult to establish precisely, as many cases remain undiagnosed or are attributed to other causes. Symptoms can be intermittent and may worsen during periods of poor glycaemic control. Diagnosis typically involves gastric emptying studies, which may include scintigraphy (the gold standard investigation) or breath testing. Upper gastrointestinal endoscopy may be performed to exclude mechanical obstruction or other structural abnormalities.

Management of diabetic gastroparesis requires a multifaceted approach. Optimising blood glucose control is fundamental, as hyperglycaemia itself can delay gastric emptying and exacerbate symptoms. A medication review is important, as certain drugs—including GLP-1 receptor agonists, opioid analgesics, and anticholinergic medications—can worsen delayed gastric emptying and should be minimised or avoided where possible. Dietary modifications play a crucial role and may include eating smaller, more frequent meals, reducing dietary fat content (which slows gastric emptying), and reducing insoluble fibre during symptomatic periods. Liquid or pureed meals may be better tolerated. Adequate hydration is essential.

Prokinetic medications such as metoclopramide or domperidone may be prescribed to enhance gastric motility, though their use requires careful consideration of potential side effects, contraindications, and regulatory restrictions. Metoclopramide should be used at the lowest effective dose for a maximum of 5 days due to the risk of extrapyramidal side effects (such as involuntary movements). Domperidone carries a risk of QT interval prolongation and serious cardiac arrhythmias, and is subject to prescribing restrictions; it should be used at the lowest effective dose for the shortest duration, with careful attention to contraindications and drug interactions, and typically under specialist oversight. Erythromycin may be considered as a short-term prokinetic under specialist supervision, though tachyphylaxis (reduced effectiveness over time) can occur. Antiemetic medications may provide symptomatic relief for nausea and vomiting. In severe, refractory cases, referral to a specialist gastroenterology service is appropriate for consideration of additional interventions.

Further information: NHS (Gastroparesis), British Society of Gastroenterology guideline on gastroparesis and chronic nausea and vomiting, MHRA Drug Safety Updates on metoclopramide and domperidone restrictions, MHRA/EMC Summary of Product Characteristics for prokinetic agents.

When to Seek Medical Advice for Stomach Pain

Knowing when abdominal pain requires medical assessment is crucial for patient safety, as some causes demand urgent investigation and treatment. People with type 2 diabetes should seek immediate medical attention (by calling 999 or attending an emergency department) if they experience severe abdominal pain, particularly if accompanied by:

• Fever and rigors, which may indicate infection or inflammation

• Persistent vomiting that prevents oral intake of fluids or medications

• Signs of dehydration, including reduced urine output, dizziness, or confusion

• Abdominal pain with rapid breathing, fruity-smelling breath, or altered consciousness, which may suggest diabetic ketoacidosis (note that DKA can occur with normal or only mildly elevated blood glucose in people taking SGLT2 inhibitors)

• Blood in vomit or stools, indicating potential gastrointestinal bleeding

• Severe pain radiating to the back, which may suggest pancreatitis

• Abdominal rigidity or rebound tenderness, which could indicate peritonitis

• Jaundice (yellowing of the skin or eyes), pale stools, or dark urine, which may indicate biliary obstruction, pancreatitis, or liver disease

• Severe chest or upper abdominal pain with sweating, breathlessness, or feeling faint, which could represent a cardiac emergency

Patients should contact their GP or diabetes care team within 24–48 hours if they experience new or worsening abdominal pain that is persistent, interferes with daily activities, or is associated with unexplained weight loss, changes in bowel habits, or difficulty managing blood glucose levels. Additionally, if abdominal pain develops shortly after starting a new diabetes medication, medical advice should be sought to determine whether the medication may be contributing to symptoms. If you are unsure whether your symptoms require urgent attention, you can call NHS 111 for advice.

It is important that patients do not dismiss abdominal symptoms as simply being "part of diabetes." A thorough clinical assessment, including history, examination, and appropriate investigations (which may include blood tests, imaging, or endoscopy), is necessary to establish the underlying cause and guide appropriate management. Early identification of serious conditions such as pancreatitis, bowel obstruction, or malignancy can significantly improve outcomes.

Further information: NHS (Stomach ache and abdominal pain, Diabetic ketoacidosis, Pancreatitis), NHS 111 (for urgent advice when unsure).

Managing and Preventing Abdominal Pain with Type 2 Diabetes

Effective management of abdominal pain in type 2 diabetes begins with identifying and addressing the underlying cause, whether this is related to the diabetes itself, its treatment, or a concurrent condition. Maintaining optimal glycaemic control is fundamental, as prolonged hyperglycaemia contributes to the development of diabetic complications, including autonomic neuropathy affecting the gastrointestinal tract. Regular monitoring of HbA1c and working with healthcare professionals to adjust treatment as needed can help prevent long-term complications.

Dietary modifications can play a significant role in managing and preventing abdominal discomfort. Eating regular, balanced meals that are consistent in carbohydrate content helps maintain stable blood glucose levels and supports digestive function. For those experiencing constipation, increasing dietary fibre and fluid intake is beneficial. For those experiencing gastroparesis or delayed gastric emptying, smaller, more frequent meals with reduced fat and insoluble fibre content may be helpful. Liquid or pureed meals may be better tolerated during symptomatic periods. Adequate hydration is essential, particularly for those taking SGLT2 inhibitors or experiencing gastrointestinal symptoms. A referral to a registered dietitian with expertise in diabetes can provide personalised dietary guidance.

Regular physical activity, as recommended by NICE and the UK Chief Medical Officers' Physical Activity Guidelines for all people with type 2 diabetes, supports both glycaemic control and digestive health by promoting regular bowel movements and reducing constipation. Patients should aim for at least 150 minutes of moderate-intensity aerobic activity per week, plus muscle-strengthening activities on two or more days per week, tailored to individual ability. Any increase in activity levels can be beneficial.

Medication review is important, particularly if abdominal symptoms coincide with treatment changes. Taking metformin with or after food and using gradual dose titration can reduce gastrointestinal side effects; the modified-release formulation may be better tolerated. Working with prescribers to optimise medication regimens—such as adjusting dosing schedules or considering alternative agents—can often improve tolerability whilst maintaining glycaemic control. Patients should never stop prescribed diabetes medications without medical advice, as this may lead to dangerous elevations in blood glucose. It is also important to follow sick-day rules during acute illness: this includes temporarily stopping SGLT2 inhibitors (as advised by your healthcare team) to reduce the risk of diabetic ketoacidosis, maintaining hydration, and monitoring blood glucose and ketones closely.

Finally, attending regular diabetes reviews and screening appointments allows for early detection of complications and provides opportunities to discuss any new or ongoing symptoms with healthcare professionals. Proactive management and open communication between patients and their diabetes care team are essential for maintaining both metabolic health and quality of life. If you suspect a side effect from any medication, you can report it via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Further information: NICE NG28 (Type 2 diabetes in adults: management), UK Chief Medical Officers' Physical Activity Guidelines, Diabetes UK (Sick day rules, including SGLT2 inhibitors), NHS (Type 2 diabetes), MHRA Yellow Card Scheme (reporting suspected side effects).

Frequently Asked Questions