Please Suggest A Diagnosis For My Brother Is 63 Years Old With Type 2 Diabetes Experiencing Bouts Of Diarhea?

Posted on Wed, 5 Apr 2023

Question: My brother is 63 years old with type 2 diabetes for 23 years. Since November he has been experiencing bouts of diarhea. Since it has become much more troublesome often times 5-8 times at night, preventing him from sleeping. It also goes on throughout the day. There has been some weight loss and general weakness. His doctor has yet to perform a colonoscopy. Blood tests and cat scan according to the endocrinologist were negative. This is extremely concerning in that he does become dehydrated and is losing all or most of his nutrition daily. Please suggest a diagnosis or plan of action.

Answered by Dr. Anders Mark Christensen (13 minutes later)

Brief Answer:
Rehydration is key

Detailed Answer:
Hi,
There are many potential causes of diarrhea. It is important to rule out infection (e.g. salmonella, Yersinia, etc.) so he should definitely have a stool test for bacteria, parasites, and worms. A colonoscopy should soon be performed. Malabsorption caused by pancreatic disease or intestinal disease should also be ruled out, the former can also be assessed from a stool sample. Intestinal disease can be assessed by a gastro-duodenoscopy (=upper endoscopy).

The most important thing right now is to keep him hydrated, preferably using electrolyte-rich fluids Measurements of daily weight are important, and weight loss should lead to parenteral nutrition being considered.

Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Anders Mark Christensen (7 hours later)

What is parenteral nutrition?
Also, the stool cultures were negative for parasites and .infection. Could his diabetes cause this is a result of years of diabetes?

Answered by Dr. Anders Mark Christensen (1 hour later)

Brief Answer:
Yes, diabetes can cause diarrhea

Detailed Answer:
Hi again,

Parenteral nutrition is to be fed food via intravenous catheters. It is not a permanent solution.

There is a condition called diabetic diarrhea, which primarily is a diagnosis of exclusion. Presumably it involves damage to bowel nerves which affects things like stool consistency. If your brother does not have a fever or blood in his stool, you could try with anti-diarrheal agents, such as loperamide, or high-fiber diet.

Hope this helps.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Anders Mark Christensen (2 days later)

My brother is on dycyclomine 2 times/ day. No blood in the stools and no cramps in the stomach. Pain in the rectum .

Answered by Dr. Anders Mark Christensen (18 hours later)

Brief Answer:
That is good.

Detailed Answer:
Hi again Simplymatching,

That is all good. Then I suggest you proceed with the advices above; anti-diarrheal medication, fiber rich diet and plenty of rehydration.

Best wishes,
Anders

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Above answer was peer-reviewed by : Dr. Vaishalee Punj