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Suggest Treatment For Diabetic Diarrhea
Question: Dear Dr,
My mother (63 years) has rheumatoid arthritis and is also undergoing treatment for uveitis. She is diabetic and hypertensive.
She has been passing motion atleast 2 or 3 times a day this past 1 year and the frequency of her motions has just increased to 7 if not stopped with a medicine like IModium. Even then its just 24 hrs and then it starts. She gets very tired and also has no appetite.
She underwent endoscopy and a colonoscopy (only half way was done as it was too painful and we asked the doctor to stop) and her results were clear. We are awaiting her tTG test results were negative. Her C-reactive protein is positive. Hb and RBC counts are less than normal (not too low).
The doctor has prescribed Sibofix 400mg (1-0-1) for 7days about 1 month ago, which didn't make any difference. The doctor said it may be SIBO or diabetic diarrohea and sent us back to our diabetologist. He 1st prescribed Ciplox TZ and when that didnt help advised her to take flagyl 400.
Even that has not helped her. She has infact also tried making changes in her diet by stopping milk and milk products...but to no gain.
Is she suffering from something else that we are missing......is it her Auto immune disease that is triggering this- she has been prescribed Tab. HCQS for the past 1.5years.
Hoping for a miracle.
thanks,
XXXX (a worried daughter)
My mother (63 years) has rheumatoid arthritis and is also undergoing treatment for uveitis. She is diabetic and hypertensive.
She has been passing motion atleast 2 or 3 times a day this past 1 year and the frequency of her motions has just increased to 7 if not stopped with a medicine like IModium. Even then its just 24 hrs and then it starts. She gets very tired and also has no appetite.
She underwent endoscopy and a colonoscopy (only half way was done as it was too painful and we asked the doctor to stop) and her results were clear. We are awaiting her tTG test results were negative. Her C-reactive protein is positive. Hb and RBC counts are less than normal (not too low).
The doctor has prescribed Sibofix 400mg (1-0-1) for 7days about 1 month ago, which didn't make any difference. The doctor said it may be SIBO or diabetic diarrohea and sent us back to our diabetologist. He 1st prescribed Ciplox TZ and when that didnt help advised her to take flagyl 400.
Even that has not helped her. She has infact also tried making changes in her diet by stopping milk and milk products...but to no gain.
Is she suffering from something else that we are missing......is it her Auto immune disease that is triggering this- she has been prescribed Tab. HCQS for the past 1.5years.
Hoping for a miracle.
thanks,
XXXX (a worried daughter)
Brief Answer:
Cause for diarrohea
Detailed Answer:
Good evening sangeeth. I understand your concerns here. Considering her age and that high frequency of loose stools, she is bound to get very weak and fatigued.
What we really need to do here is to figure out the type of diarrohea, is it small intestine one or large intestine one. or is it secretory or osmotic.
Since it has been going on for so long, I really do not think the antibiotics will make much difference.
If you can answer few of the questions, we can maybe narrow down to a cause and investigate on those lines rather than subjecting her to various investigations
1. Is it painful or painless?
2. Are they large volume motions or small amount?
3. Does it happen on fasting also or after meals.
4. Are the stools foul smelling/sticky sorts?
5. Has the stool examination been done for routine and fat examination?
6. Has she been given a trial of steroids.
I know the questions do sound a bit weird, but it will help in localizing what kind of diarrohea are we dealing with.
As for her Rheumatoid, I am not too sure about the diagnosis in the first place as HCQS alone is not enough to control the disease. Did she has her rheumatoid tests positive??Secondly Rheumatoid Arthritis does not produce diarrohea by itself. HCQS can cause Gastrointestinal upset but since she has been taking it for so long, it may not be the cause right now.
At this stage, I would want to rule out crohns disease as a possibility. It can affect any part of the intestine and can cause joint pains and uveitis as well.
Do let me know. Will try and help you out with whatever i can
Regards
Cause for diarrohea
Detailed Answer:
Good evening sangeeth. I understand your concerns here. Considering her age and that high frequency of loose stools, she is bound to get very weak and fatigued.
What we really need to do here is to figure out the type of diarrohea, is it small intestine one or large intestine one. or is it secretory or osmotic.
Since it has been going on for so long, I really do not think the antibiotics will make much difference.
If you can answer few of the questions, we can maybe narrow down to a cause and investigate on those lines rather than subjecting her to various investigations
1. Is it painful or painless?
2. Are they large volume motions or small amount?
3. Does it happen on fasting also or after meals.
4. Are the stools foul smelling/sticky sorts?
5. Has the stool examination been done for routine and fat examination?
6. Has she been given a trial of steroids.
I know the questions do sound a bit weird, but it will help in localizing what kind of diarrohea are we dealing with.
As for her Rheumatoid, I am not too sure about the diagnosis in the first place as HCQS alone is not enough to control the disease. Did she has her rheumatoid tests positive??Secondly Rheumatoid Arthritis does not produce diarrohea by itself. HCQS can cause Gastrointestinal upset but since she has been taking it for so long, it may not be the cause right now.
At this stage, I would want to rule out crohns disease as a possibility. It can affect any part of the intestine and can cause joint pains and uveitis as well.
Do let me know. Will try and help you out with whatever i can
Regards
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
1. Is it painful or painless?- PAINLESS
2. Are they large volume motions or small amount?- LARGE WHEN TAKEN NOTE OF HER VERY SMALL MEALS
3. Does it happen on fasting also or after meals. - FASTING ALSO
4. Are the stools foul smelling/sticky sorts?- SMELL WIERD AND NOT THE NORMAL STINKY and looks like its beaten in to light fluff
5. Has the stool examination been done for routine and fat examination?- ROUTINE IS DONE NOT FAT
6. Has she been given a trial of steroid- YES, WAY BACK ON 22/04/12- AS FOLLOWS
Tab. Folitrax-10mg- once a week
tab. Folvite-5mg- 4 days/weeks
tab.pantocid DSR
Tab HCQS-400mg (now it is 200mg)-0-0-1
Cap. Autrin 0-1-0
tab. Omnacartil- 5mg*3 tab*1 week
Do let us know if there are any specific tests information or tests that we need to do.....
And do u want to add any other medicine for rheumatoid arthritis to supplement Tab. HCQS
thanks
Brief Answer:
Cause for diarrohea
Detailed Answer:
Good evening Sangeeth. It looks a more like secretory type of diarrohea and the causes can be quite some which can start from some common drugs to any horomonal imbalances in the body.
Antibiotics are not going to help her in this case. There is some cause which we are missing.
I will still want to rule out crohns disease. I am still trying to figure out why the colonoscopy was so painful. I hope there was no stricture. If she cant go for colonoscopy it is advisable to get a CT Colonography done. It is as specific as colonoscopy and non invasive. Drawback is that tissue won't be available for Biopsy. Also considering her age, CECT Abdomen should be carried out.
I know you are worried, but at her age the first thing we need to rule out is any form of malignancy. If there is no structural abnormality or any other cause, we are at least sure that we are dealing with something non serious. Then it can be a motility problem which can be controlled.
Regarding her Rheumatoid arthritis, one will have to see the patient in person before recommending any more drugs. If you can let me know your location, I can guide you to a rheumatologist as well
Hope the information was useful .
Cause for diarrohea
Detailed Answer:
Good evening Sangeeth. It looks a more like secretory type of diarrohea and the causes can be quite some which can start from some common drugs to any horomonal imbalances in the body.
Antibiotics are not going to help her in this case. There is some cause which we are missing.
I will still want to rule out crohns disease. I am still trying to figure out why the colonoscopy was so painful. I hope there was no stricture. If she cant go for colonoscopy it is advisable to get a CT Colonography done. It is as specific as colonoscopy and non invasive. Drawback is that tissue won't be available for Biopsy. Also considering her age, CECT Abdomen should be carried out.
I know you are worried, but at her age the first thing we need to rule out is any form of malignancy. If there is no structural abnormality or any other cause, we are at least sure that we are dealing with something non serious. Then it can be a motility problem which can be controlled.
Regarding her Rheumatoid arthritis, one will have to see the patient in person before recommending any more drugs. If you can let me know your location, I can guide you to a rheumatologist as well
Hope the information was useful .
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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