 Hey guys, this is Dr. Ahmet Ergin. I'm an endocrinologist and a diabetes education specialist. Today, we are going to talk about Diarrhea. So if you have some loose tools going on, it may not be now, but it may be coming and going. If you have that kind of problem, tune in, because today we are going to discuss diabetes and diarrhea in detail. Ready? Let's go. Alright, so most of you must have had some diarrhea at some point in your life. But if it is a problem that is becoming persistent or on and off or chronic, in that case, you may want to consider that diarrhea may be due to diabetes. And a few other factors may play into it, but provided that your doctor has ruled out other possibilities, let's say they have done a colonoscopy, etc., in this case, you will review why diabetes can cause diarrhea. Number one, diabetes can cause neuropathy. So as you all know, neuropathy is a nerve damage from the diabetes. Now you are wired with nerves, and believe or not, you have more nerves in your intestinal system than in your brain. So as a result, the nerve damage that happens on your feet, your hands, or the wrists of your body can definitely affect your intestinal system as well. So what happens when that happens? Since you are most of the time, typically, are under the effect of nervous system to be able to digest your food, when something is wrong in that intestinal system, nervous system, then you may end up with diarrhea. Now, what else can happen? Reflex is also not uncommon. Because of the syphincter dysfunction at your esophageal syphincter, which is your food pipe, you may have reflux of the food, although you may not be necessarily eating foods that causes reflux. But just because you have a high blood sugar, you may have that tendency to have a reflux. What else? You can actually also have a dysfunction in your rectum. So you may not be able to hold the stool, especially if it is watery or excessive, then that can lead to incontinence, and that can present as diarrhea as well. What else? The same nervous system can also secrete excessive water. Now, excessive water secretion due to that nervous dysfunction can also cause the stool to be very watery. And of course, when there is a motility problem, when your intestinal system is not moving correctly, you may end up having intestinal bacterial overgrowth, which means that there will be a dysregulation or imbalance in the amount and the number of bacteria, which you should have, right? You should have a healthy amount of bacteria in your intestinal system. But if it is not correct, then you will have a bacterial intestinal overgrowth, the overgrowth of bacteria. The same bacteria, unfortunately, causes what we call malabsorption. So you are not going to be able to really absorb the food correctly, and bacteria will digest most of that food that is not absorbed, and that will create gas, bloating, and diarrhea. There are some tests that can be done for this, and the best bet is to see a gastroenterologist to get these tests done. Now, what else can you have? You're already probably asking right now, when is it going to talk about metformin, right? Yes, metformin, definitely, if you're on that, definitely can cause diarrhea. Now, what's interesting, when you're on metformin, metformin will cause diarrhea, even if it didn't at the beginning. So it may cause diarrhea years after, because remember, your intestinal system is not the same. It changes in time. The same medication can start showing a different side effect in time. So there are some other medications that can cause diarrhea, such as A-carbose, which is a generic medication. There are GLP-1 agronists that are typically very good medications, but one of the side effects can be diarrhea. Although most of the time it's temporary, but in a lot of cases, it can be persistent as well. And this GLP-1 agronist drugs are typically ozempic, Victoza, Trullicity, Bidurian, Bayata. If you're on these drugs, you may want to bring that to your doctor's attention as well to make sure that you're not taking your medication that is persistently causing diarrhea. Now, what's interesting, when you reduce the dose of these medications, diarrhea may subside and actually eventually go away, and then when you increase the dose back up again, you may not have the same side effects. What is also interesting, when we stop metformin on patients when we think that they're having diarrhea, and diarrhea goes away. And when we restart the metformin, most of the time diarrhea does not come back. So how do you explain that? Sometimes you don't have any explanation. Sometimes body's adaptation mechanisms, maybe your body remembers the metformin and next time they become better friends. Who knows? But the bottom line is those are common things we see in the practice as well. You may have also celiac disease, which is, most people call it as gluten sensitivity or gluten entropathy. If you have that, diarrhea is definitely a common problem, although sometimes it can be constipation. If you have pancreatic insufficiency, it could be from excessive alcohol use or it can be from any other cause. Chronic pancreatitis, et cetera, can lead to chronic pancreatic insufficiency. And as a result, you will not be able to have those digestive enzymes that can typically helps you digest the food and prevent them from absorption. Lust, but not least. The irritable bowel syndrome is very common, especially if you're depressed, if you have anxiety, that definitely needs to be ruled out. In older individuals, we also rule out microscopic colitis or that you will need to have a colonoscopy. Again, irritable bowel syndrome is also a syndrome where you diagnose it with the rule of elimination. So you have to rule out everything else to call it irritable bowel syndrome. And then the treatment typically is good diabetes control, good blood sugar control, because that can immediately help you with the diarrhea. If it is the medications, if we think that there are medications, then we will change or stop medications. If we think that it's bacterial overgrowth, we may do some testing for that. And most of the time, we use medications such as Imodium just to reduce the overall diarrhea. The Imodium or the Loperomide typically works by reducing the peristalsis, which is the movement of your intestinal system. So when you slow down that process, then the intestinal system will have more time to absorb the water and it will increase the transit time. And as a result, it will reduce the volume of the stool. And the asymptomatic treatment is not treating the root cause, but that's something definitely we use as a first line treatment to reduce the sequestrations and help less of a worried area. And then after that, once you have the real diagnosis, then you try to treat the bottom line root cause, of course, but excessive use can interestingly cause constipation as well. Now, one thing you also need to remember that if you have diarrhea, you will need to stay hydrated. Your electrolyte imbalance may shift, so you will need to correct it as well. Again, eating vegetables and fruits will be your best bet without being excessive. Again, portion control is very important, but that will definitely help you keeping your vitamins and minerals in check as well. If you're eating a lot of fibers, which is good, but if you make it excessive, you may not be able to digest those fibers. So that may also sometimes cause diarrhea, just to keep in mind. I hope you benefit from this video. And if you liked it, please give it a thumbs up. Please subscribe. Remember to share as well. We will see you in the next video. Bye.