How do I handle diverticulitis? I have found next to no information about how someone with type 2 diabetes on insulin should deal with bouts of diverticulitis. Please help!

Monty Miller
Tumwater, Wash.

Janis McWilliams, RN, MSN, CDE, BC-ADM, responds: Diverticula are small, bulging pouches found mostly in your large intestine. These are thought to result in part from a diet high in processed foods and too low in fiber. However, diverticulosis (the development of these pouches) is a very common condition, and the incidence increases as we age. When one or more of these pouches becomes inflamed or infected, diverticulitis develops.

Diverticulitis symptoms include abdominal pain, tenderness, fever, nausea, and constipation or diarrhea. The pain can feel like appendicitis, except it is usually in the lower left side of your abdomen instead of the lower right side.
Treatment depends on the severity of symptoms, but usually starts with a liquid or low-fiber diet and antibiotics. This can lead to difficulties for people on insulin, as you mentioned. Instead of eating a diet high in fiber and whole grains, whole fruits, and vegetables—the usual ingredients for a healthy diet—these foods need to be avoided to rest the colon until the infection heals. But this change will usually lead to a change in insulin requirements to best manage blood glucose.

It is impossible for me to make specific recommendations, as each patient is different. However, if you take a premixed insulin such as 70/30 or 75/25, it would likely be better to take a basal insulin and be able to give premeal rapid-acting shots based on what you are going to eat and the total carbohydrate content. If you are on a liquid diet, you need to be sure that it includes carbohydrates. Instead of sugar-free soda, Jell-O, and popsicles, switch to choices with calories and carbohydrates. Certain fruit juices without pulp are also allowed. Your diabetes educator can help you match your carbohydrate amount with your insulin dose.

It is good to remember that although a low-fiber diet is the treatment for diverticulitis, once the symptoms are gone, you should try to gradually increase the fiber in your diet to best avoid another attack. Regular exercise and drinking plenty of fluids also help to avoid a recurrence.