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July 24, 2001

Complications

Question from Plano, Texas, USA:

I am 42 years old, and have had type 1 diabetes for 36 years, have worn an insulin pump for four years and my hemoglobin A1c's range from 5.5 to 6.2% since wearing the pump. Prior to that, they averaged in the 7% range. In the last couple of months, I have been having bowel problems. I don't seem to have all the symptoms of gastroparesis, and I've had three doctors tell me they do not feel I have gastroparesis. I recently had a colonoscopy -- no cancer, tumors or polyps. Basically, I am only having bowel movements every three days, and it is quite a struggle to have one. I feel like my food is stuck in my rectum -- that it is very close to leaving the body, but won't go. If I try to force it, nothing happens. Finally, in about two days from that point, I usually can go, but even then I do not feel that my intestine is emptying completely. Even when I had my colonoscopy, I was on liquids and a laxative for three days, and the doctor commented there was some fecal material in the colon. I have just started on MiraLax (even though I tried it once before and it didn't seem to help), and my doctor wants to slowly introduce fiber. At my doctor's suggestion, I have begun walking after dinner to help my food move, but I have not noticed any improvement. Even though the gastroenterologist initially thought I did not have gastroparesis, he is now saying he does not know what is causing the constipation and that it might be related to my diabetes. I do not have any diarrhea, nausea or vomiting -- just constipation, the feeling that my food has stopped and is stuck in my intestine. Does this sound like gastroparesis? Do you think it is related to diabetes? Is there any treatment for this type of problem? Any info you may have or suggestions for treatment would be greatly appreciated.

Answer:

In fact, diabetes can cause gastroparesis. However, we refer to this term when there is decreased emptying of the stomach. It sounds like your lower intestine is involved. This can also be caused by diabetes, but is harder to prove. The general idea is that neuropathy does not allow normal motility and sensing of stool in the lower intestine.

I would suggest continued work with a gastroenterologist. Various causes may be considered. However, most involve symptomatic treatment of the problem.

JTL