More than 37 million Americans — or about 11 percent of the population — have diabetes, according to the Centers for Disease Control and Prevention. If you’re one of them, you might also be at risk for a condition called exocrine pancreatic insufficiency (EPI), a digestive disorder in which the pancreas doesn’t produce the enzymes that are needed to properly digest food. According to a review published in April 2020 in the journal Current Diabetes Reports, type 1 and type 2 diabetes commonly occur with mild to moderate EPI. One study cited in this review — which was itself a meta-analysis — found that EPI was reported in nearly 39 percent of patients with type 1 diabetes and more than 28 percent in those with type 2 diabetes. While researchers aren’t entirely sure why diabetes can lead to EPI, it’s thought that, in the case of type 1 diabetes, the pancreas cells that produce digestive enzymes can become damaged. The reverse is also true: If you have EPI, you could also be at risk for diabetes. In people who have EPI, the pancreas either isn’t able to produce enough of the enzymes the body needs to break down food in the digestive tract or is blocked, meaning the enzymes that are produced aren’t able to reach the digestive tract. A blockage in the pancreas can also cause partial digestion of the pancreatic tissue itself, which in turn can damage the cells that produce insulin, a hormone that helps regulate blood sugar levels. There’s more to the link between diabetes and EPI than proximity, but researchers aren’t exactly sure what it is. “Diabetes can be caused by exocrine disease, and exocrine pancreatic insufficiency can be caused by diabetes,” explains Philip D. Hardt, a physician and researcher with the University Hospital of Giessen and Marburg in Giessen, Germany. “Both are possible.” If you have diabetes, these are the signs and symptoms of EPI to be aware of: frequent diarrhea, fatty stools, weight loss, and stomach pain. Although these are some of the most common signs of EPI, these symptoms can have other causes as well. If these are new symptoms for you, you should see your doctor promptly.