March 5, 2005
Aches and Pains, Complications
Question from Hawkinge, Folkestone, Kent, UK:
I have had type 1 diabetes for 12 years. My blood sugars are well controlled. I have had diarrhea for the last 11 to 12 years, since I became diabetic, I think. I was seeing a gastroenterologist. I have had a tilt test, which initially showed I had nerve damage. The doctor who was doing the test, said it was positive without a doubt, until an old senior doctor came along and suggested another test. He held my nose, told me to breath in, and hold my breath and try to force the air out. I released the air from my mouth as I couldn’t hold it any more and the senior doctor said I didn’t have any problems because I didn’t pass out (as if I were going let myself pass out). The actual tilt test showed I had a circulation problem. I don’t think the other test he did was very scientific, do you?
I had my appendix out three years ago. It’s a long story, but the emergency doctor told me I had a urinary infection because of my diabetes and sent me home. I had chronic pain on my right side and, a day later, I went to another hospital and they did an emergency appendectomy.
I have had a white cell scan, a colonoscopy and a barium meal three years ago to investigate the diarrhea. All came back negative. Every few months, especially after my appendectomy, I have severe pain in my right side above and I think unrelated to my appendix scar. The operation went okay without any complications. I lose my appetite. About an hour after eating, I get the pain on my lower right side. I get diarrhea and feel very tired. The pain is unbearable. I asked the gastroenterologist for another colonoscopy as the last one I had was just after my appendectomy and before I started to get the pains. I think it is Crohn’s disease. My gastroenterologist told me he would not do another colonoscopy. He said there was no point. He said if the average life span is 80 years, if I had Crohn’s, I would still live 80 years and that diabetics could not be treated anyway as it involves steroids, which he said diabetics cannot take. Is this true? He said I had diabetic neuropathy, which was causing the diarrhea and pain. He said he would rather treat the worst case scenario, the neuropathy, as that could drastically reduce my life span. Then, he sent me away with nothing else but an appointment for six months! As I am getting pain, is this classed as symptomatic neuropathy? If so, I have read that not a lot of sufferers live more than five more years. Is this true and what is the likely prognosis?
I have microalbumin in my urine and my diabetic specialist has told me I have kidney damage. I currently have swollen lymph glands and they are doing ANA and ENA blood tests. Will these not be positive anyway because of my diabetes? My A1c is always very good. Due to this, my diabetic specialist never listens to what I am concerned about.
I do have lows and I just think that with my A1c, the highs are counteracted by the lows. Is this a possibility? He says I cannot have diabetic neuropathy as I have not been diabetic long enough. I am stuck in a no win situation. I guess it could well be neuropathy as the diarrhea is particularly bad when my blood sugars are high, but I guess this could be due to some sort of inflammation. As they see me as a 30 year old, they don’t take me seriously as someone this young cannot be suffering with diabetes. Sorry to go on, but I can’t talk to anyone.
I have been to my general practitioner (GP) on several occasions for the pain on my right side, which affects and causes severe pain also under my right rib, at my right kidney and the right side of my pelvis. The GP initially said it was the appendix scar, then indigestion and then maybe an infection. I have had pills, pills and more antibiotics, but nothing helps. I am in remission at the moment but get twinges. I am just getting my appetite back now. At Christmas, I was in bed for three weeks with a hot water bottle. I cannot sleep at night as my feet and legs feel like they are burning. I have told my diabetic specialist about for the last four years. He did a pin test on my feet and said my circulation was okay. Only recently has he given me the antidepressant to help when I go to sleep. I feel as if I have to get old before the diabetic specialist will listen to me and take my symptoms seriously. Please help to answer some of my questions as I cannot find anyone else to ask.
Answer:
It is true that long-term gastrointestinal disease may indicate diabetic diarrhea. This is traditionally used to refer to motility abnormalities involving the gut where the nerves that usually allow for normal passage of food and stool are involved with a form of neuropathy. It may coexist with kidney involvement as it is another form of small-vessel diabetes-related complications. Blood sugars are very hard to control when the gut is involved with neuropathy. Although diarrhea may imply that the rectum is involved, there may be simultaneous involvement of the stomach where bloating, cramping, and reflux of food materials may occur simultaneously. The irregular movement of food contents out of the stomach is a big problem for blood sugar control as it often results in highs and lows. In addition to the diabetic diarrhea, you need to consider some of the following as additional possibilities for the symptoms:
Celiac sprue can occur more frequently in patients with type 1 diabetes;
The possibility of bacterial overgrowth syndrome;
Although inflammatory bowel disease may occur, it can be ruled out. There are other treatments besides steroids. However, this has not been seen or diagnosed to date; and
Irritable bowel syndrome is a diagnosis of exclusion that results from alterations in diet, nerves, and bowel habits.
Your doctor can have you obtain a gastric emptying study. Blood levels can be obtained for sprue. You can be checked for malabsorption to see if the diarrhea has had any additional complications. Finally, there are some emperic therapies for diabetic diarrhea that you can discuss with your physician. If the results are from neuropathy, it can be a frustrating problem to treat so I recommend patience, in addition to best wishes.
JTL
