II. Pathophysiology
- General
-
Diarrhea mechanisms (esp. Type I Diabetes Mellitus)
- Stasis syndrome due to impaired Small Bowel motility
- Hypermotility due to unmitigated sympathetic activity
- Pancreatic insufficiency
- Bile salt malabsorption
- Steatorrhea
- Drug-induced causes (e.g. Metformin)
-
Constipation mechanisms
- Large Bowel dysfunction due to Neuropathy
- Impaired gastrocolic reflex
-
Fecal Incontinence mechanisms
- Anal sphincter dysfunction related to Neuropathy
- Abnormal resting tone of internal and external anal sphincter
III. Symptoms
- Diarrhea (occurs in up to 22% of patients with diabetes)
- Constipation (occurs in up to 44% of patients with diabetes)
- Fecal Incontinence
IV. Labs
V. Management: Diarrhea
- Maintain adequate hydration, Electrolyte replacement, and nutritional maintenance
- Symptomatic relief with antidiarrheal agents
- Avoid over-use due to Megacolon risk
-
Bacterial overgrowth treatment
- Trial used Augmentin for 10 days in patients with positive hydrogen breath tests
- Virally-Monod (1998) Diabetes Metab 24:530-6 [PubMed]
VI. Management: Constipation
- Eliminate Medication Causes of Constipation
- See Constipation Management