Current Gastroenterology Reports

, Volume 11, Issue 5, pp 354–359

Diabetic diarrhea

Article

Abstract

Diabetic patients with diarrhea may present clinical challenges in diagnosis and treatment. Particular diagnoses are more prevalent in diabetic patients than in the general population. Medications are often a culprit for chronic diarrhea, and the medication list should always be carefully scrutinized for those with diarrhea as a side effect. In diabetic patients, metformin is a common cause of diarrhea. Diabetic patients are more likely to have associated diseases (eg, celiac sprue and microscopic colitis) that present with diarrhea as the sole complaint. Ingested sugar-free foods that may contain sorbitol or other agents can cause diarrhea in diabetic patients. Finally, diabetic enteropathy can itself cause diarrhea. The various etiologies can be diagnosed with a thorough history and appropriate diagnostic tests. This article focuses on the etiologies of diarrhea that are seen with higher incidence in diabetic patients.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Bytzer P, Talley NJ, Leemon M, et al.: Prevalence of gastrointestinal symptoms associated with diabetes mellitus. Arch Intern Med 2001, 161:1989–1996.PubMedCrossRefGoogle Scholar
  2. 2.
    Vinik A, Erbas T: Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med 2001, 68:928–930, 932, 934–44.PubMedCrossRefGoogle Scholar
  3. 3.
    Lysy J, Israeli E, Goldin E: The prevalence of chronic diarrhea among diabetic patients. Am J Gastroenterol 1999, 94:2165–2170.PubMedCrossRefGoogle Scholar
  4. 4.
    Berchtold P, Dahlqvist A, Gustafson, A, et al.: Effects of a biguanide (Metformin) on vitamin B12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol 1971, 6:751–754.PubMedGoogle Scholar
  5. 5.
    Bytzer P, Talley NJ, Jones MP, et al.: Oral hypoglycaemic drugs and gastrointestinal symptoms in diabetes mellitus. Aliment Pharmacol Ther 2001, 15:137–142.PubMedCrossRefGoogle Scholar
  6. 6.
    Foss MT, Clement KD: Metformin as a cause of late-onset chronic diarrhea. Pharmacotherapy 2001, 21:1422–1424.PubMedCrossRefGoogle Scholar
  7. 7.
    Ratnaike RN, Jones TE: Mechanisms of drug-induced diarrhoea in the elderly. Drugs Aging 1998, 13:245–253.PubMedCrossRefGoogle Scholar
  8. 8.
    Byetta [package insert]. San Diego, CA: Amylin Pharmaceuticals; 2008. Available at http://pi.lilly.com/us/byetta-pi.pdf. Accessed April 2009.
  9. 9.
    Jacob S, Rabbia M, Meier MK, et al.: Orlistat 120 mg improves glycaemic control in type 2 diabetic patients with or without concurrent weight loss. Diabetes Obes Metab 2009, 11:361–371.PubMedCrossRefGoogle Scholar
  10. 10.
    Drent ML, van der Veen EA: Lipase inhibition: a novel concept in the treatment of obesity. Int J Obes Relat Metab Disord 1993, 17:241–244.PubMedGoogle Scholar
  11. 11.
    Acarya NV, Wilton LV, Shakir SA: Safety profile of orlistat: results of a prescription-event monitoring study. Int J Obes (Lond) 2006, 30:1645–1652.CrossRefGoogle Scholar
  12. 12.
    Sellin JH, Chang EB: Therapy insight: gastrointestinal complications of diabetes-pathophysiology and management. Nat Clin Pract Gastroenterol Hepatol 2008, 5:162–171.PubMedCrossRefGoogle Scholar
  13. 13.
    Kerlin P, Wong L: Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 1988, 95:982–988.PubMedGoogle Scholar
  14. 14.
    MacMahon M, Gibbons N, Mullins E, et al.: Are breath hydrogen tests valid in the elderly? Gerontology 1996, 42:40–45.CrossRefGoogle Scholar
  15. 15.
    Bauer TM, Schwacha H, Steinbrückner B, et al.: Diagnosis of small intestinal bacterial overgrowth in patients with cirrhosis of the liver: poor performance of the glucose breath hydrogen test. J Hepatol 2000, 33:382–386.PubMedCrossRefGoogle Scholar
  16. 16.
    Stotzer PO, Kilander AF: Comparison of the 1-gram (14)C-D-xylose breath test and the 50-gram hydrogen glucose breath test for diagnosis of small intestinal bacterial overgrowth. Digestion 2000, 61:165–171.PubMedCrossRefGoogle Scholar
  17. 17.
    Rhodes JM, Middleton P, Jewell DP: The lactulose hydrogen breath test as a diagnostic test for small bowel bacterial overgrowth. Scand J Gastroenterol 1979, 14:333–336.PubMedCrossRefGoogle Scholar
  18. 18.
    Riordan SM, McIver CJ, Walker BM, et al.: The lactulose breath hydrogen test and small intestinal bacterial overgrowth. Am J Gastroenterol 1996, 91:1795–1803.PubMedGoogle Scholar
  19. 19.
    Corazza GR, Menozzi MG, Strocchi A, et al.: The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology 1990, 98:302–309.PubMedGoogle Scholar
  20. 20.
    Sellin JH, Hart R: Glucose malabsorption associated with rapid intestinal transit. Am J Gastroenterol 1992, 87:584–589.PubMedGoogle Scholar
  21. 21.
    Aktay AN, Lee PC, Kumar V, et al.: The prevalence and clinical characteristics of celiac disease in juvenile diabetes in Wisconsin. J Pediatr Gastroenterol Nutr 2001, 33:462–465.PubMedCrossRefGoogle Scholar
  22. 22.
    Rensch MJ, Merenich JA, Lieberman M, et al.: Glutensensitive enteropathy in patients with insulin-dependent diabetes mellitus. Ann Intern Med 1996, 124:564–567.PubMedGoogle Scholar
  23. 23.
    Talal AH, Murray JA, Goeken JA, et al.: Celiac disease in an adult population with insulin dependent diabetes mellitus: use of endomysial antibody testing. Am J Gastroenterol 1997, 92:1280–1284.PubMedGoogle Scholar
  24. 24.
    Fasano A, Berti I, Gerarduzzi T, et al.: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003, 163:286–292.PubMedCrossRefGoogle Scholar
  25. 25.
    Dretzke J, Cummins C, Sandercock J, et al.: Autoantibody testing in children with newly diagnosed type 1 diabetes mellitus. Health Technol Assess 2004, 8:iii–xi, 1–183.Google Scholar
  26. 26.
    Larsson K, Carlsson A, Cederwall E, et al.: Annual screening detects celiac disease in children with type 1 diabetes. Pediatr Diabetes 2008, 9:354–359.PubMedCrossRefGoogle Scholar
  27. 27.
    Salardi S, Volta U, Zucchini S, et al.: Prevalence of celiac disease in children with type 1 diabetes mellitus increased in the mid-1990s: an 18-year longitudinal study based on anti-endomysial antibodies. J Pediatr Gastroenterol Nutr 2008, 46:612–614.PubMedGoogle Scholar
  28. 28.
    Remes-Troche JM, Rios-Vaca A, Ramírez-Iglesias MT, et al.: High prevalence of celiac disease in Mexican Mestizo adults with type 1 diabetes. J Clin Gastroenterol 2008, 42:460–465.PubMedCrossRefGoogle Scholar
  29. 29.
    Kaistha A, Castells S: Celiac disease in African American children with type 1 diabetes mellitus in inner city Brooklyn. Pediatr Endocrinol Rev 2008, 5(Suppl 4):994–998.PubMedGoogle Scholar
  30. 30.
    Smyth, DJ, Plagnot V, Walker NM, et al.: Shared and distinct genetic variants in type 1 diabetes and celiac disease. N Engl J Med 2008, 359:2767–2777.PubMedCrossRefGoogle Scholar
  31. 31.
    Plenge RM: Shared genetic risk factors for type 1 diabetes and celiac disease. N Engl J Med 2008, 359:2837–2838.PubMedCrossRefGoogle Scholar
  32. 32.
    Bohr J, Tysk C, Eriksson S, et al.: Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients. Gut 1996, 39:846–851.PubMedCrossRefGoogle Scholar
  33. 33.
    Olesen M, Eriksson S, Bohr J, et al.: Lymphocytic colitis: a retrospective clinical study of 199 Swedish patients. Gut 2004, 53:536–541.PubMedCrossRefGoogle Scholar
  34. 34.
    Pardi DS, Ramnath VR, Loftus EV Jr, et al.: Lymphocytic colitis: clinical features, treatment, and outcomes. Am J Gastroenterol 2002, 97:2829–2833.PubMedCrossRefGoogle Scholar
  35. 35.
    Koskela RM, Niemel SE, Karttunen TJ, et al.: Clinical characteristics of collagenous and lymphocytic colitis. Scand J Gastroenterol 2004, 39:837–845.PubMedCrossRefGoogle Scholar
  36. 36.
    Warren BF, Edwards CM, Travis SP: ’Microscopic colitis’ classification and terminology. Histopathology 2002, 40:374–376.PubMedCrossRefGoogle Scholar
  37. 37.
    Corazza GR, Strocchi A, Rossi R, et al.: Sorbitol malabsorption in normal volunteers and in patients with coeliac disease. Gut 1988, 29:44–48.PubMedCrossRefGoogle Scholar
  38. 38.
    Bauditz J, Norman K, Biering H, et al.: Severe weight loss caused by chewing gum. BMJ 2008, 336:96–97.PubMedCrossRefGoogle Scholar
  39. 39.
    Nunes ACR, Pontes JM, Rosa A, et al.: Screening for pancreatic exocrine insufficiency in patients with diabetes mellitus Am J Gastroenterol 2003, 98:2672–2675.PubMedCrossRefGoogle Scholar
  40. 40.
    Hardt PD, Hauenschild A, Nalop J, et al.: High prevalence of exocrine pancreatic insufficiency in diabetes mellitus. A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. Pancreatology 2003, 3:395–402.PubMedCrossRefGoogle Scholar
  41. 41.
    Hahn JU, Kerner W, Maisonneuve P, et al.: Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas 2008, 36:274–278.PubMedCrossRefGoogle Scholar
  42. 42.
    Ewald N, Bretzel RG, Fantus IG, et al.: Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of prospective multi-centre trial. Diabetes Metab Res Rev 2007, 23:386–391.PubMedCrossRefGoogle Scholar
  43. 43.
    Taniguchi T, Okazaki K, Okamoto M, et al.: High prevalence of autoantibodies against carbonic anhydrase II and lactoferrin in type 1 diabetes: concept of autoimmune exocrinopathy and endocrinopathy of the pancreas. Pancreas 2003, 27:26–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Hardt PD, Ewald N, Bröckling K, et al.: Distinct autoantibodies against exocrine pancreatic antigens in European patients with type 1 diabetes mellitus and nonalcoholic chronic pancreatitis. JOP 2008, 9:683–689.PubMedGoogle Scholar
  45. 45.
    Schrader H, Menge BA, Schneider S et al.: Reduced pancreatic volume and beta-cell area in patients with chronic pancreatitis Gastroenterology 2009, 136:513–522.PubMedCrossRefGoogle Scholar
  46. 46.
    Wald A, Tunuguntla AK: Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med 1984, 310:1282–1287.PubMedCrossRefGoogle Scholar
  47. 47.
    Russo A, Botten R, Kong MF, et al.: Effects of acute hyperglycaemia on anorectal motor and sensory function in diabetes mellitus. Diabet Med 2004, 21:176–182.PubMedCrossRefGoogle Scholar
  48. 48.
    Fillmann HS, Llessuy S, Marroni CA, et al.: Diabetes mellitus and anal sphincter pressures: an experimental model in rats. Dis Colon Rectum 2007, 50:517–522.PubMedCrossRefGoogle Scholar
  49. 49.
    Fedorak RN, Field M, Chang EB: Treatment of diabetic diarrhea with clonidine. Ann Intern Med 1985, 102:197–199.PubMedGoogle Scholar
  50. 50.
    Mourad FH, Gorard D, Thillainayagam AV et al.: Effective treatment of diabetic diarrhoea with somatostatin analogue, octreotide. Gut 1992, 33:1578–1580.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Section of GastroenterologyBaylor College of MedicineHoustonUSA

Personalised recommendations