Suggest Ways To Manage Depression And IBS When On Metformin

Posted on Fri, 12 Jun 2015

Question: I am t2 diabetic. I take 5mg glyburide and 500mg metformin 3 times a day with meals. Other meds are Cymbalta 60mg, atenonol for heart palp.(mitral valve regurgitation+2). I have experienced bowel changes fall of 2013. We vacationed in Hawaii March 26-April 3 2014. I got sick on 4/1-naseau,diarreha,headache through 4/8. I called doc and said about being in Hawaii, symptoms and he scheduled a colonoscopy 4/26. Continued diarrhea through the month-no suggestion for relief. GI doc removed 2 pre-cancerous polyps and another polyp. Still diarrhea 2 weeks later went to ER found campylobacter, antibiotic and test showed it was gone. Ever since, I have had diarrhea and explosive diarrhea, cramps, bloating, nausea, tons of mucus, sweating and lately some blood. I have to strain to go at times with painful groans- but stool is NOT hard but on the runny side of soft. I threw a fit and had them check for parasites but no common ones found(Hawaii, road side fruit stand, salads etc.) I still have not ruled out a rogue parasite-no one has looked at what has come out! I am so miserable, I feel exhausted constantly and sleep a lot. Docs will not recognize that metformin could be the culprit. At 1000mg 2 times a day I had issues- so the reduction-but when I ask to change to other meds. was told it is not the problem, they are expensive, can increase glypizide but it causes lows(last A1C 7.5) so here I am! The diagnosis is it is IBS with constipation. REALLY! That came from 5 months ago when I told them bm's started with passing little hard balls (small amount) followed by diarrhea. That changed to no hard balls to all water. I use probiotics, tried fiber which really made more gas, upset stomach. If soft bm is formed it is narrow and grooved or narrow and flattened. Any thoughts or HELP!

Answered by Dr. Binu Parameswaran Pillai (2 hours later)

Brief Answer:
Measures to improve depression and IBS. Reduce Metformin and observe

Detailed Answer:
Good day,

Noted your concerns and really sorry to hear about it. I can imagine how miserable it is.

I did notice that, you have had bowel issues even in 2013, even before your trip to Hawai. So you must have had a pre existing condition which might have got worsened by Hawai trip. I doubt if the polyps had any role in these symptoms at all !!!. However, sice they were precancerous, you need follow up scans.

You could stop Metformin for 2 weeks and see if there is any change in your bowel habits. Yes, sugars might go up a bit and we may need to modify Glyburide dose or may need to add insulin. But if the symptoms are due to Metformin, you will feel the difference in a week to 10 days.

Diabetic diarrhea is another thing to consider. You may have to discuss with your gastroenterologist about it.

Try adding Yougurt with live cultures twice a day to your diet. Continue other probiotics. You may also try with pills like Amitryptylline at night.. This will tackle depression as well as IBS ( if any). But you need prescripion from your PCP or endocrinologist.

Avoid alcohol and smoking. Drink clean water. Eat fresh fruits.

Regards
Binu

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar