Diabetes mellitus: malabsorption

It is known that with diabetes, diarrhea and steatorrhea are possible . The latter is due to:    

– violation of exocrine pancreatic function ;  

– concomitant celiac disease (detected histologically in 6% of patients receiving insulin);  

– excessive growth of bacteria in the proximal small intestine;

– severe untreated diabetes in itself.

In the first three cases, pancreatic enzymes , gluten-free diet, and antibacterial therapy are indicated, respectively . The causes of diarrhea and steatorrhea in the fourth case are unclear. Perhaps they are due to autonomic neuropathy . Sometimes such patients have excessive growth of bacteria in the small intestine, exacerbating malabsorption.          

The clinical picture in cases where diarrhea and steatorrhea develop against the background of diabetes mellitus is quite typical. Typically, this complication occurs in young men with insulin-dependent diabetes mellitus , which is severe and difficult to treat. Neuropathy is characteristic , including autonomic ( orthostatic hypotension , anhydrosis , impotence , neurogenic bladder dysfunction ), and angiopathy . Radiography reveals delayed emptying of the stomach and impaired motility of the small intestine . There is no change in the small intestine biopsy. With samples for absorption, only steatorrhea and azotorrhea are detected .                        

Pancreatic enzymes , a   gluten-free diet and   glucocorticoids do not produce a lasting effect. With excessive growth of bacteria in the small intestine,   broad-spectrum antibiotics are indicated . 

Persistent diarrhea is sometimes caused by diet foods with a lot of sorbitol. For severe diarrhea resistant to diet and M-anticholinergic drugs , clonidine is used .      

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