Have Diabetes and Digestive Problems? Dr. Rudert discusses possible reasons and simple solutions tha
Dr. Rudert, gastroenterologist and celiac expert, discusses crucial information every diabetic with digestion problems should know in order to improve their health, and well-being. Find out why people with diabetes might be more likely to have digestive problems, and how some simple treatments may improve digestion and overall long term health! Read the story of a 25 year old patient named Ariel (name has been changed for privacy) with Type I diabetes with ongoing digestive problems that were resolved with treatment recommended by Dr. Rudert. Find out why probiotic and / or pancreatic enzyme therapy might also help you!
Case History:
Ariel is a 25 year old graduate in Musical Theatre who was diagnosed with type I diabetes at the age of 8.Her blood glucose has been well regulated and she has had an insulin pump for a year. She had been very active and enjoyed good health until she developed "stomach problems" five months earlier. She complained of ongoing fatigue, gas, bloating, nausea, abdominal discomfort, intestinal cramping and occasional loose stools. Her only other medication besides insulin is a nasal decongestant which she takes as needed.
How common are gastrointestinal problems in type I diabetics?
Dr. Rudert answers:
Complaints such as these are relatively common and not unique to diabetes. However, in my experience, diabetics often have an underlying bacterial imbalance called small intestinal bacterial overgrowth (SIBO). This is often treated with probiotics and sometimes antibiotics in selected circumstances. Ariel improved approximately 50% on a specific combination of probiotic therapies. Patients may also have intestinal infections (ex. giardia), medication induced side effects, celiac disease and a variety of other explanations for their symptoms. Nothing replaces a thorough history and physical exam!
What's the next step?
Dr. Rudert answers:
The next step was to see if there might be other causes for the digestive problems. Testing showed that stool studies were negative for infection/parasites and comprehensive testing for celiac disease was negative. Celiac disease coexsists in 8% of all Type I diabetics which is 8X higher than the general population. Blood testing is not 100% and 10% of celiacs are seronegative.
What was the diagnosis?
Dr. Ruder answers:
Testing showed that Ariel had Exocrine Pancreatic Insufficiency (EPI).
What is EPI?
Dr. Rudert answers:
I see a lot of patients US wide for 2nd, 3rd, 4th, etc opinion consults and EPI is one of the most common disorders missed in gastroenterology. When the exocrine pancreas is damaged it can no longer make the appropriate amounts of enzymes needed for digestion so complaints like Ariel's may occur. When you don't digest your food this also leads to a bacterial imbalance which explains why she had partial improvement with probiotic therapy.
How common is EPI in Type I diabetes?
Dr. Rudert answers:
Studies have been published for over a decade from Dr. Philip Hardt's group in Germany.They found that 50% of Type I and 30% of Type II patients may have this commonly missed disorder (EPI). I had the pleasure of meeting his colleague when he presented their latest findings at PancreasFest 2014.
What is the treatment for EPI?
Dr. Rudert answers:
Prescription pancreatic enzymes are taken with every meal and snack in capsule form by mouth. These porcine derived enzymes provide amylase to digest starch, lipase to digest fat and protease to digest protein. If this condition is not recognized and treated, long term complications may result including vitamin deficiencies and osteoporosis.
Ariel also had a low Vitamin D as a result of unrecognized EPI.
Will taking pancreatic enzymes affect blood sugar levels?
Dr. Rudert answers:
Sometimes blood glucose levels may be altered since the patient is now able to absorb the nutrients from their meals. Patients should monitor glucose levels as required.
How is Ariel doing now?
Dr. Rudert answers:
Sweet Ariel is doing great and her nausea, pain, loose stools and fatigue are almost completely resolved. When we last met she said, " my real nasty stomach....well, I'm 95% better!" We can always still aim for 100%! Ariel is continuing with her probiotic and pancreatic enzyme therapy and is experiencing improved digestion and better energy.
For more information, please contact our office.
