Diabetes and Gallstones: Is There a Link?

BY AMY CAMPBELL, MS, RD, LDN, CDCES | APRIL 14, 2022

Your gallbladder is pear-shaped organ that sits under your liver. Its main job is to store bile, a fluid made by your liver that digests fat. When you eat food, your stomach releases a hormone that causes the muscles around the gallbladder to contract and release bile. All well and good … until you start having pain, nausea, and vomiting, and maybe even a fever or chills. While these symptoms can indicate many issues, they may point to gallstones. Learn more about gallstones and how they might be linked to diabetes.

What are gallstones?

Gallstones (cholelithiasis) are hard, pebbly-looking pieces of material that form in the gallbladder. They are usually made from cholesterol, bile salts, or a substance called bilirubin, which is made from the breakdown of red blood cells.

There are two main types of gallstones:

• Cholesterol stones, that are hardened cholesterol and are yellow-green in color
• Pigment stones, that are made of bilirubin and dark in color

Some people have a combination of both types of stones.

Gallstones come in different sizes, ranging from miniscule like a grain of sand to the size of a golf ball. Your gallbladder might make one big gallstone, hundreds of tiny stones, or a combination of both. When gallstones block the bile ducts (the tubes that connect the liver and gallbladder to the small intestines), a serious and even life-threatening infection may occur in the bile ducts, pancreas, or liver.

What are symptoms of gallstones?

Gallstones may not cause any symptoms, at first. But if they get larger or start to block bile ducts, symptoms (often called “attacks”) may occur. These include:

• Pain in your upper right abdomen that can last for several hours
• Pain between your shoulder blades
• Pain in your right shoulder
• Indigestion
• Nausea or vomiting
• Fever or chills

Gallbladder attacks tend to occur after eating a heavy meal and usually occur in the evening or during the night. The attacks usually stop when the gallstones move and are no longer blocking the bile ducts. You can have gallstones that don’t block bile ducts, and these don’t cause symptoms. These “silent gallstones” that don’t cause symptoms don’t prevent your gallbladder, liver, or pancreas from working, so they don’t need treatment.

When should you seek medical attention right away?

If you have any of these symptoms during or after a gallbladder attack, call your doctor immediately:

• Abdominal pain lasting several hours
• Nausea and vomiting
• Fever or chills
• Jaundice (a yellowish color in your skin or in the whites of your eyes)
• Tea-colored urine
• Light-colored stools

These symptoms could indicate inflammation or an infection of the gallbladder, liver, or pancreas. They can also be signs of other serious conditions, such as appendicitis, ulcers, pancreatitis, or gastroesophageal reflux disease.

What causes gallstones?

Gallstones are formed if bile has too much cholesterol or bilirubin, or not enough bile salts, or if the gallbladder doesn’t empty as it should. Some people are more likely to have gallstones because of certain risk factors, including obesity and certain types of dieting.

What factors increase your risk of gallstones?

Gallstones affect 10% to 15% of the adult population; in the U.S., 20 to 25 million people have or will have gallstones. Certain groups of people have a higher risk of getting gallstones than other people:

• Women (women using estrogen or who are pregnant are more likely than other women to have gallstones)
• Older people
• People with a family history of gallstones
• Native Americans
• Mexican Americans

Also, having any of the following health conditions increases your risk of gallstones:

• Cirrhosis
• Hemolytic anemias
• Leukemia
• Intestinal diseases, such as Crohn’s disease
• Diabetes
• Overweight or obesity

People with type 2 diabetes may have a higher risk of gallstones if they are overweight. Also, they are more likely to have high triglycerides, which is a type of fat that can encourage gallstone formation. People with diabetes may have impaired gallbladder motility as well as autonomic neuropathy, which can promote gallstone development.

Another factor that can increase gallstone development is diet. Specifically, people who lose weight very quickly, say, from weight-loss surgery or from following a very-low-calorie diet. Weight cycling, in which you lose and regain weight repeatedly, may also lead to gallstones. Fasting can decrease gallbladder movement, leading to a high concentration of cholesterol in the bile.

How are gallstones diagnosed?

In addition to noting the presence of symptoms, your health care provider will likely review your medical and family history, and do a physical exam. They may order certain tests, such as:

• Blood tests
• Imaging tests, such as an ultrasound, CT scan, or MRI to help detect gallstones and view the organs in your abdomen
• Cholescintigraphy, which involves an injection of a radioactive material to diagnose abnormal gallbladder contractions or a blockage in the bile ducts
• Endoscopic retrograde cholangiopancreatography (ERCP), a procedure that involves inserting an endoscope into the stomach and small intestine to view the biliary ducts

How are gallstones treated?

Gallstones that are causing “attacks” and pain will likely require treatment. Treatment may include:

• Cholecystectomy, which is the removal of the gallbladder. Bile will then flow directly from the liver into the small intestine. (You don’t need your gallbladder to survive). You may have loose stools, but if this persists, a medication called cholestyramine can help.
• Medications to dissolve gallstones (oral dissolution therapy). Ursodiol and chenodiol are medicines that contain bile acids and can break up gallstones. These medicines are best used for small gallstones. It may take months or years of treatment to break up the stones.
• Methyl-tert-butyl ether. This is a solution injected into the gallbladder to dissolve stones.
• Shock wave lithotripsy. This blasts gallstones into small pieces.

Can you prevent gallstones?

You can lessen the chances of having gallstones by doing the following:

• Not fasting or skipping meals
• Losing weight slowly (1 or 2 pounds per week)
• Eating high-fiber foods, including fruits, vegetables, and whole grains
• Eating fewer refined carbohydrate foods, including sugar
• Reaching and staying at a healthy weight
• Eating healthy fats (olive oil, fatty fish, avocado) to help your gallbladder contract and empty regularly
• Aiming to keep your blood sugar and A1C levels (a measure of long-term blood glucose control) within your target range