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From Chestertown, Maryland, USA:

I have read about diabetes diarrhea, but I also heard it could be a virus. My son is three. He was diagnosed in January. He takes Lispro and NPH, two injections daily. He has diarrhea every other week for that amount of time. My doctor here says it's a virus, but I'm having a hard time believing that he's getting a virus every other week. My doctor is not really hands on with a lot of children with diabetes. In the county, they may diagnose one child a year. I was wondering if maybe you had some suggestions I could bring up to the doctor and we could check them out.


Intestinal issues that can be a consequence of diabetes are not common, and I would hesitate to say do not occur at all in newly diagnosed children with diabetes. I believe you are referring to issues that surround poorly controlled diabetes that has been present for years and years and years. This issue has to do with damage to the nerves of the intestines that regulate the intestinal muscles that control digestion and bowel habits. I agree with you that it would seem odd to have virus after virus to cause recurring bouts of diarrhea.

This is probably an issue that you would want to bring up to your general pediatrician. A number of possibilities come to my mind and only a couple may be related at all to diabetes. Your pediatrician may wish to consider "chronic toddler's diarrhea, " which usually self-resolves, but there might be easily treated things such as lactose intolerance. More worrisome issues, again unrelated to diabetes, might include inflammatory bowel disease. If antibiotics have been used repeatedly, there is a process that sometimes has been called "pseudo membranous colitis" which is a consequence of excessive use of antibiotics which has caused the normal intestinal germs to be overrun by some non-helpful germs. Other bacteria that can cause chronic diarrhea include salmonella, shigella, and yersinia, but those children tend to appear ill.

Issues that might be indirectly related to diabetes that your doctor may wish to explore would include other autoimmune issues, similar to what causes type 1 diabetes, such as hyperthyroidism or celiac disease. Frankly, I think these would be less likely in a three year old than some of the other issues I have noted above. I'd have you talk with your general pediatrician about this. Have you had a referral to a pediatric endocrinologist? I am assuming, by your letter, that your child is followed by an internist/endocrinologist who primarily cares for adults. If so, please ask for a referral to a pediatric endocrinologist. There are several in your state at the major university medical centers and perhaps even some in private practice. Perhaps a neighboring state's medical center or pediatric hospital is even closer.


Original posting 26 Apr 2004
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