II. Pathophysiology

  1. General
    1. Autonomic Neuropathy
  2. Diarrhea Mechanisms (esp. Type I Diabetes Mellitus)
    1. Stasis syndrome due to impaired Small Bowel motility
    2. Hypermotility due to unmitigated sympathetic activity
    3. Pancreatic insufficiency
    4. Bile salt malabsorption
    5. Steatorrhea
    6. Drug-induced causes (e.g. Metformin)
  3. Constipation Mechanisms
    1. Large Bowel dysfunction due to Neuropathy
    2. Impaired gastrocolic reflex
  4. Fecal Incontinence Mechanisms
    1. Anal sphincter dysfunction related to Neuropathy
    2. Abnormal resting tone of internal and external anal sphincter

III. Symptoms

  1. Diarrhea (occurs in up to 22% of patients with diabetes)
  2. Constipation (occurs in up to 44% of patients with diabetes)
  3. Fecal Incontinence

V. Management: Diarrhea

  1. Maintain adequate hydration, electrolyte replacement, and nutritional maintenance
  2. Symptomatic relief with antidiarrheal agents
    1. Avoid over-use due to Megacolon risk
  3. Bacterial overgrowth treatment
    1. Trial used Augmentin for 10 days in patients with positive hydrogen breath tests
    2. Virally-Monod (1998) Diabetes Metab 24:530-6 [PubMed]

VI. Management: Constipation

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