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Question:

From Canada:

My boyfriend has had type 1 diabetes since he was a child. There have been three times where he will get a series of cramps, bloating, gas and diarrhea for hours and all night. I was reading some comments on the net about stomach and bowel problems. This one person states that, at first, about four times a year they will get foul burping, vomit then have watery stool all night and sometimes have accidents. This person also said that the gastric emptying shocked their doctor because it showed that this person emptied too fast.

These symptoms are all the things that my boyfriend has, including that accidents where he is very embarrassed, especially when it happens at my house. Is this connected to Irritable Bowel Syndrome (IBS)? I'm not too sure what I'm talking about because I am fairly new to this all. My boyfriend HATES doctor and refuses to go, I don't think he even has his every six month check-up. He promised me that, this time, he would make an appointment this time but who knows? I was hoping that you would know what it was or what we should do or how we could understand this better.

Answer:

I hope your boyfriend finds a physician he can work with. If you are going to have a long-term relationship with him, I would probably remind him that he needs to invest in his own health. I hope that is not too harsh. The problem is that none of his problems will be effectively addressed if he doesn't get some help.

It is true that patients with type 1 diabetes can have gastrointestinal problems as complications from diabetes. Neuropathy, or complications to the nervous system, can be the root of the problem. It turns out that nerves do not do well in a constant environment of high blood sugars. The degree of dysfunction is related to how long he has had high blood sugars and how high the sugars actually get. Over time, when the nerves are exposed to high sugars, they are ineffective at making energy and can actually be permanently damaged or die as a result of neuropathy. The nerves that control the motility of the esophagus, stomach, small intestine, large intestine, and the sphincters in the anus can all be involved.

There are several terms used to describe neuropathy involving the gastrointestinal tract. One common example is gastroparesis. This refers to the inability of the stomach to empty appropriately. Food stays in the stomach causing nausea, bloating, and a delay in glucose absorption (since glucose has to get to the small intestine to be absorbed). Because food is not moved, ulcers or esophagitis or retention of plant cellulose may occur. The other common disorder is referred to as diabetic diarrhea, which results in the loss of tone of the sphincters that maintain fecal continence. You can also have loss of bladder control if the urethral sphincters or bladder are involved. Both may occur at the same time. Medications are not always helpful and it can be a disabling problem. Finally, blood sugars can be very difficult to control in this setting.

There is also another condition that is associated with type 1 diabetes called celiac disease. This condition is not associated with neuropathy but causes diarrhea, bloating, and abdominal discomfort. It is caused by an acquired condition involving the small intestine. It is screened for using blood tests and endoscopy. Your boyfriend needs to ask his doctor to test for this.

My recommendation is for your boyfriend to get help from physicians he can work with. These are not easy problems to deal with.

JTL

DTQ-20050725172109
Original posting 26 Jul 2005
Posted to Complications and Other

  
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Last Updated: Tuesday April 06, 2010 15:10:02
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