Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>
A woman with type 1 diabetes of 47 years duration has retinopathy, microalbuminuria, peripheral neuropathy, gastroparesis and coronary artery disease. Glycemic control is much improved now that she switched to continuous subcutaneous insulin infusion pump therapy. Her last HbA1c was 7.1% without hypoglycemia. Most of her complications are stable and quiescent. However, last year she began experiencing severe explosive diarrhea. An extensive work-up including upper and lower endoscopy with biopsies, serum tissue transglutaminase IgA and IgG, assessment for fecal fat, testing for parasites and stool culture were all negative. Other than vitamin D deficiency, there was no evidence of malabsorption or other micronutrient deficiencies. She was hospitalized twice for intractable diarrhea and dehydration. Last winter, she tried to manage with scheduled-dose loperamide which resulted in severe fecal impaction and another hospitalization. The gastrointestinal complications of diabetes are some of the most challenging to manage. Diabetic diarrhea can be difficult to distinguish from the more common irritable bowel syndrome. It can alternate with constipation or periods of normal bowel function. Diarrhea can be nocturnal and can result in incontinence of stool. The causes include autonomic neuropathy with abnormal bowel motility, small bowel bacterial overgrowth, bile acid malabsorption and anorectal dysfunction. Celiac sprue and exocrine pancreatic insufficiency are more common in type 1 diabetes and should also be ruled out. There are several treatment options. Increasing daily fiber intake to at least 15-20 gm day can be helpful. However, fiber could result in bezoar formation in patients with constipation or gastroparesis. Bacterial overgrowth may be treated with three weeks o Continue reading >>
Serotonin 5-ht3 Receptor Antagonist For Treatment Of Severe Diabetic Diarrhea
Diabetic diarrhea is a troublesome gastrointestinal complication of diabetes. This condition persists for several weeks to months, and it frequently accompanies fecal incontinence. The cause of diabetic diarrhea is not fully understood, but autonomic neuropathy is thought to be an underlying mechanism (1). Parenteral somatostatin analog octreotide has been shown to be useful in the treatment of severe long-standing diabetic diarrhea (1). Selective serotonin 5-hydroxy tryptamine type 3 (HT3) receptor antagonist, which was developed as an antiemetic in cancer chemotherapy, prolongs colonic transit, inhibits small bowel secretion, and decreases colonic compliance (2). Here, we report the underlying mechanism of ramosetron (2), a selective serotonin 5-HT3 receptor antagonist, for the treatment of severe diabetic diarrhea. A 37-year-old man, who developed type 2 diabetes at 30 years of age, presented with watery diarrhea in late February 2009. Diarrhea occurred at a frequency of >15 bowel movements in 24 h, with a high nocturnal frequency and fecal incontinence. After 2–3 days with diarrhea, the patient developed constipation for 4–5 days. His A1C level had remained at ∼10% for the previous 4 years. He had simple diabetic retinopathy, numbness, and dull pain in the lower limbs but no microalbuminuria. The coefficient of variation of the R-R interval was reduced to 1.24%. He also presented with retrograde ejaculation. Steatorrhea was absent, and the bacterial culture of his stool revealed normal flora. Abdominal computed tomography revealed no abnormal lesions in the liver or the pancreas. The patient did not report abdominal pain or any other abdominal symptoms and had no signs of infectious disease. His body weight did not change after the development of diarrhea. He Continue reading >>
Tweet Diarrhoea is commonly experienced as a result of gastroenteritis but may also be caused by specific medication including statins and metformin. Diarrhoea is defined as passing loose, watery stools more than three times a day. Diarrhoea may also result from conditions such as irritable bowel syndrome, coeliac disease and autonomic neuropathy. Common causes of diarrhoea The NHS lists gastroenteritis, bowel infection, as the most common cause of diarrhoea. Gastroenteritis can be caused by a bacterial or viral infection. Other relatively common causes of diarrhoea include: Food intolerances - such as lactose or gluten intolerance Irritable Bowel Syndrome Drinking too much coffee or alcohol Read further below for causes more specifically related to diabetes. Diagnosing diarrhoea In most cases diarrhoea will clear within a week. If diarrhoea persists longer is accompanied by other symptoms such as: Fever Blood in your stools Vomiting Unexplained weight loss If you have recently been treated in hospital or have recently been put onto antibiotics see your GP. To diagnose the cause of persistent diarrhoea, your GP will review the medications you are on and will likely ask questions about your bowel movements and other questions which may help to isolate a possible cause. Your GP may need to take a stool sample or a blood test or perform a rectal examination if further information is needed. Treating diarrhoea Depending on the cause of diarrhoea, treatment may vary. See further below for more about specific causes related to diabetes. Whilst you have diarrhoea, it is important to take regular drinks of fluid, ideally water, as you will lose more water than usual through diarrhoea. High blood glucose, which can also commonly result from viral infections, can also increase th Continue reading >>
Diarrhea In Diabetes, Introduction And More:
Information on: Diabetic Gastroparesis and more Read more about diabetic: esophagus / stomach / bowels The Diabetic Bowels: Issues and Challenges, Constipation/Diarrhea. Diarrhea: Introduction, Small bowel Bacterial Overgrowth / Treatments for diarrhea / General Bowel Tips Diarrhea in diabetes, Introduction and more: The passage of loose and frequent stools with a sense of urgency is not uncommon with diabetics. Little research has been done in this area. Chronic diarrhea does occur in the general population and needs investigation when it interferes with daily routines. Investigations into causes of diarrhea are similar to those covered above under constipation. Causes of diarrhea in diabetics are thought to be related to: Celiac disease (wheat or gluten intolerance) Small bowel bacterial overgrowth Ano-rectal disorders Inadequate breakdown of sugars (fructose, lactose and sorbitol) in the small intestine Constipation can be a cause of diarrhea: more liquid stool may escape around a hard stool impaction. Pancreatic insufficiency Problems of altered motility related to a malfunctioning gut nervous system as well as to excessive gut secretions brought on by diabetes are also thought to play a role in diabetic diarrhea. Celiac disease is a genetic inability to digest specific proteins found in grains. Poor digestion of the protein, or gluten, often causes problems of chronic diarrhea, weight loss and fatigue. Celiac disease is found in association with Type 1 diabetes. A simple blood test screens for celiac disease in Type 1 diabetics who have a history of diarrhea. A small bowel tissue biopsy taken during an endoscopic procedure of the upper gut is often used to confirm the diagnosis of celiac disease. A word about sorbitol and naturally occurring sugars Many people may Continue reading >>
Diabetic Diarrhea. Pathophysiology, Diagnosis, And Management.
Abstract Idiopathic diarrhea is a common complication of diabetes mellitus. It occurs frequently, but not exclusively, in patients with poorly controlled insulin-dependent diabetes who also have evidence of diabetic peripheral and autonomic neuropathy. Associated steatorrhea is common and does not necessarily imply a concomitant gastrointestinal disease. The diarrhea is often intermittent; it may alternate with periods of normal bowel movements, or with constipation. It is typically painless, and occurs during the day as well as at night and may be associated with fecal incontinence. Multiple pathogenic mechanisms have been implicated, autonomic neuropathy, bacterial overgrowth, and pancreatic exocrine insufficiency being the most important underlying aberrations. However, diabetic diarrhea does not have a uniform and unequivocal pathogenesis. The diagnosis depends on a judicious clinical assessment accompanied by a stepwise laboratory evaluation, which allows the differentiation idiopathic diabetic diarrhea from the many other causes of diarrhea that can occur in diabetic and nondiabetic patients. The management can be difficult but many therapies, including antibiotics to eradicate bacterial overgrowth, as well as antidiarrheal agents, oral and topical clonidine, and somatostatin analogues may be effective in controlling diabetic diarrhea. Continue reading >>
Diabetes And The Gastrointestinal Tract
Gastrointestinal (GI) disorders are common among all people, including those affected by diabetes. At some point in any patient's life, the chances that he or she will develop a GI tract problem, be it peptic ulcer disease, gallstones, irritable bowel syndrome, food poisoning, or some other malady, are extremely high. As many as 75% of patients visiting diabetes clinics will report significant GI symptoms. The entire GI tract can be affected by diabetes from the oral cavity and esophagus to the large bowel and anorectal region. Thus, the symptom complex that may be experienced can vary widely. Common complaints may include dysphagia, early satiety, reflux, constipation, abdominal pain, nausea, vomiting, and diarrhea. Many patients go undiagnosed and under-treated because the GI tract has not been traditionally associated with diabetes and its complications. Both acute and chronic hyperglycemia can lead to specific GI complications. Diabetes is a systemic disease that may affect many organ systems, and the GI tract is no exception. As with other complications of diabetes, the duration of the disorder and poor glycemic control seem to be associated with more severe GI problems. Patients with a history of retinopathy, nephropathy, or neuropathy should be presumed to have GI abnormalities until proven otherwise, and this is best determined by asking a few simple questions. (See "Patient Information".) Many GI complications of diabetes seem to be related to dysfunction of the neurons supplying the enteric nervous system. Just as the nerves in the feet may be affected in peripheral neuropathy, involvement of the intestinal nerves may lead to enteric neuropathy. This is a type of autonomic or "involuntary" neuropathy and may lead to abnormalities in intestinal motility, sensat Continue reading >>
Constipation And Diarrhea From Diabetes
Many people know diabetes can raise their odds of having heart disease and stroke. But it can affect your digestive tract, too. Digestion begins the minute you take a bite of food and ends a day or two later with a trip to the bathroom. The whole process is handled by the same part of your nervous system that controls other body functions that happen automatically, like your heartbeat and breathing. But over time, high blood sugar can damage the tiny blood vessels and nerves in your body, including your digestive system. A speed-up or slow-down of the process in your intestines could result in diarrhea or constipation. Diabetes medications, certain foods, and related illnesses can cause diarrhea, too. Nerve Damage About 60% to 70% of people with diabetes have some form of nerve damage, or diabetic neuropathy. It can develop at any time, but the longer you have diabetes, the more likely it is. When diabetes damages the nerves in your stomach and intestines, they may not be able to move food through normally. Most often, this causes constipation, but you can also get alternating bouts of constipation and diarrhea, especially at night. Misfiring nerves may not contract the muscles that mix and move the stuff in your intestines, so everything slows down. Your colon absorbs more moisture from the waste, which makes your poop harder -- and harder to pass. Constipation that lasts a long time can cause other health problems, such as fecal impaction, a hard lump of poop that blocks your rectum so nothing can get out. Fluid that lingers in your small intestine too long can allow too much bacteria to grow. This could lead to bloating, belly pain, and diarrhea. Nerve damage in your large intestine may let fluids move through too fast, or cause problems with absorbing and releasing Continue reading >>
How To Treat Diabetic Diarrhea?
I have a problem that I never see addressed. I've had type 1 diabetes for 36 years and been diagnosed as having diabetic diarrhea. Numerous tests have ruled out all other gastrointestinal problems. Is there any treatment for this problem? Continue reading >>
Is Diarrhea A Symptom Of Diabetes?
Diabetes occurs when your body is unable to produce or use insulin. Insulin is a hormone that your pancreas releases when you eat. It allows your cells to absorb sugar. Your cells use this sugar to make energy. If your body isn’t able to use or absorb this sugar, it builds up in your blood. This causes your blood sugar levels to increase. The two types of diabetes are type 1 and type 2. People with either form of diabetes experience many of the same symptoms and complications. One such complication is diarrhea. About 22 percent of people with diabetes experience frequent diarrhea. Researchers are unsure whether this is related to issues in the small bowel or the colon. It’s unclear what causes persistent diarrhea in people who have diabetes. Most people have experienced diarrhea at one point in their lives. People with diabetes may often need to pass a significant amount of loose stool at night. Being unable to control a bowel movement, or having incontinence, is also common in people who have diabetes. Diarrhea may be regular, or it may alternate with periods of regular bowel movements. It may also alternate with constipation. Learn more: Diabetes and constipation: What’s the connection? » The cause for the connection between diabetes and diarrhea isn’t clear, but research suggests that neuropathy may be a factor. Neuropathy refers to numbness or pain resulting from nerve damage. If you have diabetes, high blood sugar levels can damage your nerve fibers. This generally occurs in the hands or feet. Issues with neuropathy are common causes for many of the complications that accompany diabetes. Another possible cause is sorbitol. People often use this sweetener in diabetic foods. Sorbitol has proven to be a potent laxative in amounts as small as 10 grams. An imba Continue reading >>
Metformin As A Cause Of Late-onset Chronic Diarrhea.
Abstract Metformin is an effective and commonly administered drug for controlling plasma glucose concentrations in patients with type 2 diabetes mellitus. Gastrointestinal adverse effects such as abdominal pain, nausea, dyspepsia, anorexia, and diarrhea are common and widely accepted when occurring at the start of metformin therapy. Diarrhea occurring long after the dosage titration period is much less well recognized. Our patient began to experience nausea, abdominal cramping, and explosive watery diarrhea that occasionally caused incontinence after several years of stable metformin therapy A trial of metformin discontinuation resolved all gastrointestinal symptoms. A review of the literature revealed two reports that suggest diarrhea occurring long after the start of metformin therapy is relatively common, based on surveys of patients with diabetes. Metformin-induced diarrhea is differentiated from diabetic diarrhea, which is clinically similar, except diabetic diarrhea is rare in patients with type 2 diabetes. Patients with type 2 diabetes who are taking metformin and experience diarrhea deserve a drug-free interval before undergoing expensive and uncomfortable diagnostic tests, even when the dosage has been stable over a long period. Continue reading >>
What's The Connection Between Diabetes And Diarrhea?
No one wants to talk about diarrhea. More so, no one wants to experience it. Unfortunately, diarrhea is often the body's natural way of expelling waste in liquid form when a bacterial or viral infection, or parasite is present. However, there are other things that can cause diarrhea for everyone, and some things that can cause diarrhea specifically in those with diabetes. Diabetes and diarrhea There are various things that can cause diarrhea. These include: Large amounts of sugar alcohols, such as sorbitol, that are often used in sugar-free products Some medications, such as metformin, a common medication used to treat diabetes In some cases, such as with illness or the use of sugar alcohols, diarrhea does not last for long. It tends to stop once the illness is over or the person stops using sugar alcohols. With metformin, the symptoms can go away with time. Some people in whom the diarrhea does not resolve may need to stop taking the medication, however. Bowel diseases may cause lasting problems for people with these conditions. Diarrhea and other symptoms can be managed or controlled with lifestyle changes such as stress reduction, and medications as needed. People with type 1 diabetes are at higher risk of celiac disease, and should check for this if long-term diarrhea is a problem for them. A long-term complication associated with diabetes that can lead to long-term diarrhea (and constipation) is called autonomic neuropathy. Autonomic neuropathy occurs when there is damage to the nerves that control how the body works. Autonomic neuropathy can affect the nerves that control all automatic bodily functions such as heart rate, sweating, and bowel function. Since diabetes is the most common cause of autonomic neuropathy, people with long-term diabetes complications stru Continue reading >>
Diabetic Diarrhea - Causes, Symptoms And Management
Diabetic diarrhea is a type of diarrhea caused by nerve damage which disrupts the functioning of the bowel. People suffering from diabetes are also more prone to diarrhea caused by other things. Coping with diabetes is hard on its own but is made even more difficult with this complication. People don't always know that diabetes and diarrhea can go together. Read on to find out about this distressing symptom, the causes, its symptoms and management. Diabetic Diarrhea Caused by Nerve Damage Autonomic neuropathy is the medical term for damage to the nerves that carry information from your brain to your glands and organs. These nerves normally work to control organs like your bowel, bladder, heart and sexual organs without you being aware of it. When diabetic diarrhea strikes it is because the nerves controlling your bowel have been damaged. During the night our nervous system normally ensures that our bowels are quiet so that we can sleep but if the nerves are damaged then this does not happen and night time diarrhea can be the result. Nerves which control the sphincters allowing the passage of feces can also be damaged leading to incontinence. This type of nerve damage is usually associated with type 1 diabetes and is more common if the diabetes is long standing and has been poorly controlled. It is very rare in type 2 diabetes but it can happen especially if the person is an insulin dependent diabetic. The incidence of this type of diarrhea is difficult to estimate as it is often confused with other types of diarrhea. Figures of 4-22% for people with type 1 diabetes but only 0.4% for type 2 have been given. Diabetic Diarrhea Symptoms Watery painless diarrhea Night time diarrhea (nocturnal diarrhea) Episodes of diarrhea along with periods of normal bowel movements or even Continue reading >>
People with diabetes are more likely to experience chronic diarrhea than the general population. Researchers believe this is the often the result of a condition known as diabetic neuropathy. This diarrhea often comes and goes, and it may be accompanied by an inability to control bowel movements. Short-term treatment may involve medications that relieve symptoms; medications used for long-term control of diabetic diarrhea include Catapres, certain antibiotics, and somatostatin analogs. What Is Diabetic Diarrhea? People with diabetes can get diarrhea just like anyone else. Common causes include viral or bacterial infections and certain medical conditions, such as celiac disease or irritable bowel syndrome (see Diarrhea Causes). Some medications used to treat diabetes also can cause diarrhea. Yet diabetics are also more likely than most people to get chronic diarrhea because of their condition. This is known as diabetic diarrhea. There are several reasons why diabetic diarrhea is thought to occur. Sometimes it occurs because of overgrowth of bacteria in the intestines. It may also occur because of problems with the pancreas, which leads to poor absorption of nutrients. However, researchers believe that the most common reason involves a condition called diabetic neuropathy. Understanding Diabetic Neuropathy People with diabetes can, over time, have damage to nerves throughout the body. This is known as diabetic neuropathy. This condition can lead to numbness, and sometimes pain and weakness, in the hands, arms, feet, and legs. However, diabetic neuropathy can also cause problems in every organ system, including the digestive tract. Nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea. Problems with the digestive system may also Continue reading >>
• Idiopathic diarrhea is a common complication of diabetes mellitus. It occurs frequently, but not exclusively, in patients with poorly controlled insulin-dependent diabetes who also have evidence of diabetic peripheral and autonomic neuropathy. Associated steatorrhea is common and does not necessarily imply a concomitant gastrointestinal disease. The diarrhea is often intermittent; it may alternate with periods of normal bowel movements, or with constipation. It is typically painless, and occurs during the day as well as at night and may be associated with fecal incontinence. Multiple pathogenic mechanisms have been implicated, autonomic neuropathy, bacterial overgrowth, and pancreatic exocrine insufficiency being the most important underlying aberrations. However, diabetic diarrhea does not have a uniform and unequivocal pathogenesis. The diagnosis depends on a judicious clinical assessment accompanied by a stepwise laboratory evaluation, which allows the differentiation idiopathic diabetic diarrhea from the many other causes of diarrhea that can occur in diabetic and nondiabetic patients. The management can be difficult but many therapies, including antibiotics to eradicate bacterial overgrowth, as well as antidiarrheal agents, oral and topical clonidine, and somatostatin analogues may be effective in controlling diabetic diarrhea. (Arch Intern Med. 1990;150:262-267) Continue reading >>