The "little thing" of upsetting the stomach really doesn't have to go to a gastroenterologist! Because this may also be the ghost of diabetes...
Source: Endocrine Channel of the Medical Community
Author: Wang Jianhua, Diabetes Diagnosis and Treatment Center, Jinan Hospital, Shandong Province
Chief physician
Causes and clinical manifestations of diabetic bowel disease
Diabetic bowel disease (also known as "diabetic gastrointestinal dysfunction") is one of the common chronic complications of diabetes mellitus, with an incidence of up to 10% to 20%. The disease includes two forms: diabetic constipation and diabetic diarrhea. Whether it is diarrhea or constipation, the cause is due to the damage of high blood sugar to the autonomic nerve that innervates the gastrointestinal tract, in addition, diabetic constipation is also related to the patient's metabolic disorders, negative protein balance, abs and perineal muscle tone weakening resulting in weak bowel movements.
Unlike infectious diarrhea (such as bacterial dysentery), diabetic diarrhea is mainly manifested as stubborn night diarrhea or postprandial diarrhea, which has the characteristics of painless, intermittent attacks, and can return to normal after the attack period; some patients show constipation and diarrhea alternately: up to 20 to 30 times a day during the attack period, loose or watery stools, no pus blood (except when co-infected), routine stool examination and stool pathogen culture are mostly negative, and antibiotic therapy is often ineffective.
We know that the normal physiological activities of the intestine are carried out under the regulation of the autonomic nerves of the intestine. The autonomic nerves of the intestine are divided into two categories: sympathetic and parasympathetic, which inhibit the motor and secretory function of the intestine, while parasympathetic is the opposite. Under the action of pathogenic factors, if the autonomic nerve function of the intestine is disturbed, the digestion and absorption function of the human intestine will be abnormal: the parasympathetic nervous system excitability is enhanced, and the intestinal movement innervated by it is accelerated, and the patient will have diarrhea; if the sympathetic nervous system is overexcited, the intestinal peristalsis slows down, and the patient will have constipation.
The dangers of diabetic gastrointestinal dysfunction
Long-term constipation can lead to the inability toxins in the feces in the intestine to be excreted in time, and aggravate the damage to the metabolic environment of the body through absorption, resulting in the occurrence and development of related complications. Repeated diarrhea can lead to a further decline in the body's resistance due to malnutrition.
In addition, severe diarrhea in diabetic patients can cause electrolyte disorders and ketoacidosis, further damage islet cells, resulting in fluctuations in blood glucose, difficult to control, and damage to large, medium, and small blood vessels and microcirculation throughout the body. Some diabetics can also develop "emaciated" and "fragile" diabetes due to long-term recurrent severe diarrhea, which increases the difficulty of treatment.
Treatment of diabetic gastrointestinal disorders
1. Strictly control blood sugar: try to choose insulin, avoid taking oral hypoglycemic drugs that can cause gastrointestinal reactions, such as α-glycosidase inhibitors, metformin, etc.;
2. Repair damaged nerves: methyl vitamin B12 can be given orally or intramuscularly, two weeks for a course of treatment; ganglioside ester 20 to 40 mg, intramuscular injection, once a day; aldose reductase inhibitor 150 mg / day; inositol 6 g / day, continuous administration for 2 to 3 months;
3. Symptomatic treatment:
1) Patients with diarrhea can choose loperamide, diphenoxylate hydrochloride, hexagonal montmorillonite and so on as appropriate;
2) Constipated people should first adjust the diet structure, increase the intake of dietary fiber (about 30 grams per day), and appropriately increase exercise. If the effect is not obvious, laxative drugs are added and enemas are given if necessary.
According to the different mechanisms of action, laxatives can be divided into irritating laxatives (if guides, aloe vera capsules, senna, rhubarb, etc.), hyperosmolar laxatives (such as magnesium sulfate, sorbitol, lactulose, etc.), lubricating laxatives (such as hemp seed intestinal pills, kaiser, sesame oil, etc.) and volumetric laxatives (such as agar, cellulose). Gastric motility drugs can promote intestinal peristalsis, but also have a certain laxative effect, suitable for diabetic patients with weakened bowel movement.
There are two points to note:
1. Diabetic gastrointestinal dysfunction is generally non-infectious diarrhea, do not abuse antibiotics, otherwise it will lead to intestinal dysbacteriosis, and some can even cause moldy diarrhea;
2. Diabetic patients should not take irritating laxatives for a long time, because they can damage the intestinal mucosa and intestinal wall plexus, but aggravate constipation. It is best to choose a volumetric laxative drug (such as dietary fiber) and gastric motility drugs, the dosage should start from a small dose, gradually increase; it is not suitable for long-term continuous medication, and different types of drugs should be used intermittently and alternately, so as to avoid dependence on laxative drugs.
Details reminder: Type 2 diabetic patients with gastrointestinal symptoms as prominent manifestations, due to the insidious onset, lack of typical symptoms such as thirst, polydipsia, polyuria, etc., are easily misdiagnosed as digestive tract diseases. Therefore, for stubborn constipation or non-infectious diarrhea that occurs in the elderly, in addition to thinking of digestive tract diseases such as dyspepsia, chronic colitis, and intestinal tumors, we must also pay attention to excluding endocrine diseases such as diabetes and hyperthyroidism, especially do not forget to detect blood sugar.
Reading this, it is advisable to combine the two cases to deepen the impression:
Case 1
In the past six months, Grandma Zhang has somehow often diarrhea, the stool is thin or watery, no pus and blood, ranging from 2 to 6 times a day, but neither fever nor abdominal pain. The condition is repeated and severe. There were no abnormalities in stool tests and colonoscopy, and he had taken a variety of digestive aids, antidiarrheals and antibiotics, but none of them were effective.
Two days ago, my daughter took Grandma Zhang to the endocrinology department of our hospital for treatment, and through asking for medical history, she learned that although Grandma Zhang was significantly emaciated than half a year ago, the amount of food increased a lot more than before. Blood sugar was significantly elevated, and the diagnosis was eventually "diabetes", and diarrhea was also caused by diabetes.
Case 2
Uncle Zhang, who is more than seventy years old, has been suffering from constipation in recent years, often defecating once every 4 to 5 days, exhausting every time he defecates, and sometimes having to go to the hospital for enemas to solve the problem. To this end, he has been to a number of hospitals for diagnosis and treatment, and has taken a lot of gastrointestinal motility drugs, but the effect is not obvious. Not long ago, he found that his blood sugar increased during the physical examination, was diagnosed with diabetes, and received insulin therapy under the advice of a doctor, his blood sugar was effectively controlled, and constipation miraculously disappeared. It turned out that the culprit that caused Uncle Zhang's constipation was also diabetes.
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