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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Idiopathic senile chronic pancreatitis (CP) appears to be a special subtype of nonalcoholic CP. Main clinical features are onset after the age of 50 years, prevalence in men, a painless clinical course, marked weight loss associated with diarrhea (steatorrhea) or diabetes mellitus, and pancreatic calcific deposits. Idiopathic senile CP constitutes about two thirds of cases of nonalcoholic CP, but it is rare compared with the incidence of alcoholic CP. The relationship of idiopathic senile CP to the "normal" age-related morphologic and functional abnormalities of the exocrine pancreas is unknown.
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PMID:Chronic pancreatitis in the elderly. 226 25

Gastric emptying, mouth-to-cecum transit and whole gut transit of a solid-liquid meal were measured in 43 insulin-treated diabetics and in 30 control subjects by using scintigraphic techniques, the hydrogen breath test and stool markers. In the diabetics various parameters including duration of diabetes, gastrointestinal symptoms and complications such as autonomic neuropathy, peripheral neuropathy and proteinuria were determined and related to gastrointestinal transit times. Gastric emptying was significantly prolonged in diabetics as compared to the control group (p less than 0.05) with 35% of the diabetics disclosing abnormally delayed gastric emptying, whereas no significant overall differences were observed between diabetics and controls concerning mouth-to-cecum transit and whole gut transit time. However, abnormally prolonged mouth-to-cecum transit was detected in 23% and delayed whole gut transit in 26% of the diabetics (p less than 0.02 as compared to the control group). There was a significant correlation of dyspeptic symptoms and diarrhea with prolonged gastric emptying (p less than 0.001). Gastric emptying, but not mouth-to-cecum transit or whole gut transit was significantly related to autonomic nerve dysfunction (p less than 0.001) and peripheral neuropathy (p less than 0.02). Furthermore, gastric emptying and WGT were significantly correlated to proteinuria (p less than 0.03). Using a linear regression model, autonomic neuropathy, diarrhea and dyspeptic symptoms were the major parameters in predicting delayed gastric emptying. It is concluded that in diabetics different compartments of the gut are affected by gastrointestinal motor abnormalities and that these segments are probably regulated by independent or different control mechanisms.
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PMID:Gastrointestinal transit disorders in patients with insulin-treated diabetes mellitus. 230 21

Idiopathic diarrhea is a common complication of diabetes mellitus. It occurs frequently, but not exclusively, in patients with poorly controlled insulin-dependent diabetes who also have evidence of diabetic peripheral and autonomic neuropathy. Associated steatorrhea is common and does not necessarily imply a concomitant gastrointestinal disease. The diarrhea is often intermittent; it may alternate with periods of normal bowel movements, or with constipation. It is typically painless, and occurs during the day as well as at night and may be associated with fecal incontinence. Multiple pathogenic mechanisms have been implicated, autonomic neuropathy, bacterial overgrowth, and pancreatic exocrine insufficiency being the most important underlying aberrations. However, diabetic diarrhea does not have a uniform and unequivocal pathogenesis. The diagnosis depends on a judicious clinical assessment accompanied by a stepwise laboratory evaluation, which allows the differentiation idiopathic diabetic diarrhea from the many other causes of diarrhea that can occur in diabetic and nondiabetic patients. The management can be difficult but many therapies, including antibiotics to eradicate bacterial overgrowth, as well as antidiarrheal agents, oral and topical clonidine, and somatostatin analogues may be effective in controlling diabetic diarrhea.
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PMID:Diabetic diarrhea. Pathophysiology, diagnosis, and management. 180 18

In previous studies we found that in healthy subjects, 5 and 10 g of a partially purified amylase inhibitor delayed and decreased starch digestion and reduced postprandial plasma glucose after a starch meal but produced diarrhea in two of six and four of six subjects, respectively. Thus, we wondered whether lower doses of the inhibitor, when given with a meal that contained protein and fat as well as carbohydrate, would have the same effect on carbohydrate tolerance without causing diarrhea. Eight healthy subjects were randomized to receive 2.0 or 2.9 g of the inhibitor with a 650-calorie meal that contained carbohydrate, fat, and protein. In comparison with a placebo, ingestion of 2.9 g, but not 2.0 g, of the inhibitor significantly reduced postprandial increases in plasma glucose (P less than 0.05), C peptide (P less than 0.03), and gastric inhibitory polypeptide (P less than 0.008). Similarly, 2.9 g of the inhibitor in comparison with 2.0 g was associated with more carbohydrate malabsorption and more breath hydrogen excretion. Because the carbohydrate malabsorption observed with the 2.9-g dose was similar to that with the previously tested 5- and 10-g doses of the inhibitor but diarrhea was less frequent, impurities in the partially purified preparation may, in part, have been responsible for these adverse effects. We conclude that 2.9 g of the amylase inhibitor given with a meal that contains a mixture of nutrients is effective in increasing carbohydrate tolerance without causing diarrhea. Therefore, this dose is appropriate for use in studies to determine whether the inhibitor has a beneficial effect in patients with diabetes mellitus or obesity.
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PMID:Effect of a purified amylase inhibitor on carbohydrate metabolism after a mixed meal in healthy humans. 243 11

A partially purified amylase inhibitor given with a single meal causes maldigestion of carbohydrate, increases delivery of carbohydrate to the ileum, and reduces postprandial plasma glucose. To determine the effect of more prolonged administration of the inhibitor on gastrointestinal function and carbohydrate tolerance, we studied 6 non-insulin-dependent diabetics (3 previously treated with oral agents and 3 treated with diet alone) for 3 wk while they ate a weight-maintenance diet. Patients taking oral agents continued them during the first week. During the second week, 4-6 g of the inhibitor was given with each meal. Capillary blood glucose concentration was measured before each meal and 90 min postprandially. On the last day of each week venous blood samples for glucose, hormones, and lactic acid analysis and a quantitative stool culture were obtained. Total carbohydrate absorption was estimated by comparing postprandial breath hydrogen on study days 7, 14, and 21 with breath hydrogen after ingesting 15 g of lactulose on days 0, 15, and 22. There 24-h stools were collected and weighed at the end of each week and analyzed for carbohydrate, lactic acid, short-chain fatty acids, pH, dry matter, amylase, and fat. The inhibitor significantly (p less than 0.05) reduced postprandial plasma glucose, C-peptide, insulin, and gastric inhibitory polypeptide concentrations, significantly increased (p less than 0.05) breath hydrogen excretion, and caused carbohydrate malabsorption. Diarrhea occurred the first day the inhibitor was ingested, but thereafter cessation of diarrhea was associated with changes in the metabolism of carbohydrate by colonic flora. As the amylase inhibitor improves carbohydrate homeostasis and is not associated with continuing diarrhea, it may be a useful adjuvant in the treatment of patients with non-insulin-dependent diabetes mellitus.
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PMID:Gastrointestinal and metabolic effects of amylase inhibition in diabetics. 244 48

Nineteen diabetic patients with autonomic neuropathy were enrolled in a double-blind crossover study of cisapride, metoclopramide and placebo. Symptoms were evaluated from diary cards and from assessments undertaken at the end of each eight week treatment period. Measurements of oesophageal transit, gastric emptying and whole gut transit were made before treatment began and at the end of each treatment period. Three patients dropped out early in the study, and the results from 16 patients were analysed. The severity of autonomic neuropathy, judged from cardiovascular reflex tests, correlated with delayed oesophageal transit and prolonged gastric emptying, but abnormal oesophageal transit and gastric emptying were often unrelated to the presence of upper gastrointestinal symptoms. Neither cisapride nor metoclopramide had a statistically significant effect on oesophageal transit, gastric emptying or whole-gut transit, nor was any significant effect on symptoms identified, although a trend towards reduced nausea and vomiting with metoclopramide and reduced epigastric fullness and diarrhoea with cisapride was suggested. Upper gastrointestinal symptoms correlate poorly with objective abnormalities of gastrointestinal motor function in diabetes. In consequence, the symptomatic benefit to be expected from correction of these motor abnormalities remains uncertain.
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PMID:Evaluation of oral cisapride and metoclopramide in diabetic autonomic neuropathy: an eight-week double-blind crossover study. 249 59

423 cataract patients and 608 controls between the ages of 50 and 79 were interviewed in a case-control study in Oxfordshire. Diabetes, myopia, glaucoma, peripheral neuropathy and severe diarrhoea were identified as risk factors. The excess risk experienced by females with diabetes was confirmed. The trauma of surgery for glaucoma may be largely responsible for the appearance of glaucoma as a risk factor. Severe diarrhoea has now been identified as a risk factor in England and in India. The risk associated with peripheral neuropathy may indicate a common aetiology at least for some proportions of the two conditions.
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PMID:Risk factors for cataract in Oxfordshire: diabetes, peripheral neuropathy, myopia, glaucoma and diarrhoea. 255 2

In order to elucidate a regeneration of the pancreas, morphological and functional changes after major pancreatic resection were sequentially investigated in dogs. Within the first week after major pancreatectomy, the acinar cell division occurred, followed by hypertrophy resulting in an increase of the weight of the remnant pancreas. The regeneration rate correlated with the resection rate, glucose tolerance test, and insulin secretion of the remnant pancreas. Immediately after resection of more than 92% of the pancreas, severe diabetes and diarrhea developed. The regeneration rate was 29.9 +/- 6.03% (mean +/- SD) three to six weeks after surgery, without any recovery of the exocrine function. After twelve weeks following resection of 74 to 92% of the pancreas, so-called Sandmeyer's diabetes developed. The regeneration rate was 45.3 +/- 4.22% in the nondiabetic group, accompanied with a good recovery of the exocrine function, but in the diabetic group it revealed regeneration rate of 15.4 +/- 2.39% with less recovery of the exocrine function. When less than 74% of the pancreas was resected, no significant changes were observed in both morphological and functional studies in the remnant pancreas with regeneration rate of 5.5 +/- 6.62%.
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PMID:[Experimental studies on regeneration of the pancreas--morphological and functional restoration of the remnant pancreas after major pancreatectomy]. 258 32

The aim of this study was to evaluate the frequency of a thickened subepithelial collagen band in the colon, its relationship to diarrhea, and the clinical relevance of its detection. During a 3.5 year period (May 1985-January 1989), a total of 3,323 biopsy specimens were obtained during 6,254 colonoscopies. A subepithelial collagen thickening greater than 10 microns was found in 40 patients (1.5 percent of the patients). Further assessment of these 40 patients showed that this histological lesion was characterized by a frequent association with chronic diarrhea (in 36 patients, i.e. 90 percent) whatever the cause, with diseases such as diabetes mellitus (8 cases) or inflammatory arthropathies (6 cases) and with a microscopic colitis in all cases. Course of collagen thickening was variable and independent of clinical course. Diarrhea was a constant finding when the collagen thickening was greater than 15 microns and frequently improved (12 patients/14) during treatment with Collagenan. This study suggests that a subepithelial thickened collagen band is an uncommon change in the colon and is frequently associated with chronic diarrhea. The significance of this morphological change is unknown, and its contribution to the pathogenesis of the diarrhea remains questionable.
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PMID:[Collagen colitis. Reflections apropos of 40 patients]. 259 90

Gastrointestinal disorders associated with diabetes mellitus have a prevalence rate of 30 to 75%. The most prominent disorders are gastroparesis, diarrhea, and constipation. Severity of symptoms range from mild to severe with the most affected patients being at risk for the development of protein calorie malnutrition. An historical review of the major studies which defined the diagnosis, pathophysiology, and prevalence of these disorders is presented. Guidelines for accurate nutritional assessment, which is essential to the decision to initiate nutritional therapy in this difficult to assess population, are also included. Current methods devised for treatment of diabetic gastroparesis and related disorders are presented. Emphasis is placed on recent developments in nutritional support techniques which make it possible to meet the energy requirements of all such patients. Practical outlines for glucose control in patients receiving TPN or enteral feeding and guidelines for transitioning from parenteral feeding to an oral diet are also presented.
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PMID:Overview of gastrointestinal disorders due to diabetes mellitus: emphasis on nutritional support. 264 46


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