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February 10, 2003

Other Illnesses

Question from Langley, Washington, USA:

My almost 18 year old daughter, who has had a seizure disorder since birth and was diagnosed with type 1 diabetes I nine years ago, has been ill for a month. The pediatrician says a mild case of whooping cough. She coughs so hard she vomits many times daily. X-rays showed impacted bowels, but they appear to have been cleared and, while her cough is going away, she continues to vomit, usually within 20 minutes of eating or drinking anything. This is not the first time a vomiting episode has occurred due to impacted bowels. Her diet is good, and her hemoglobin A1c are below 7% historically. Could the impaction and vomiting be a result of diabetes? What can I do to adjust her diet? What kinds of medications can she take to help? The doctors we have been seeing are stumped.

Answer:

This is a difficult question to answer as there are many questions left unanswered such as: Does she have developmental delay? Have the seizures left her vegetative? What are her other maintenance medications for seizures? What is she on now for the pertussis (whooping cough). Has that diagnosis been proven with special tests? I do not know why your doctors would be “stumped”, and you should ask them these important questions.

However, in general, poorly controlled type 1 diabetes for a number of years could affect intestinal motility and lead to diarrhea or constipation. Other hormone problems that can be associated with type 1 diabetes, such as hypothyroidism, can lead to constipation too. But you do not describe your daughter as having poorly diabetes control. If she is significantly neurologically impaired and not active, then I would presume that is the major cause of chronic constipation. If she is not neurologically impaired, then chronic constipation could be related to various medications or diet.

Typically, the approach is to “purge” out the obstruction with stool softeners or mineral oil and then to keep matters “flowing” by their on-going use and the use of fiber. I would not advise use of enemas without her doctor’s blessing.

DS