Mechanisms of Chronic Diarrhea in Diabetes Mellitus

Table 71-1 provides an overview of the pathophysiological mechanisms and conditions associated with diarrhea in diabetes. The mechanisms of chronic diarrhea in diabetes are incompletely understood. However, several commonly

Table 71-1 Mechanisms, Concomitant Conditions, and Clinical Characteristics of Diarrhea in Diabetes Mellitus

Pathophysiological Associated Mechanism Disease

Clinical Presentation

Exocrine pancreatic insufficiency Celiac sprue SB bacterial overgrowth Bile acid malabsorption

Diarrhea, steatorrhea

SB dysmotility Colonic dysmotility Decreased a-2-adrenergic tone in enterocytes

Constipation or diarrhea

Anorectal dysfunction Sensory neuropathy IAS-sympathetic EAS-pudendal neuropathy

Diarrhea or incontinence

SB = small bowel; IAS = internal anal sphincter; EAS = external anal sphincter.

encountered mechanisms for diarrhea in patients with diabetes should be considered. Diarrhea may result from intake of medications or the excessive use of dietetic foods that contain sorbitol as a sweetener. Autonomic neuropathy (Vinik et al, 2003) or diseases associated with diabetes, such as celiac disease, may be the underlying causes of chronic diarrhea.

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