8178 Uncontrolled Diabetes Mellitus Presenting As Chronic Diarrhea

Abstract Disclosure: H.D. Nguyen: None. Introduction: Majority of patients with newly diagnosed diabetes mellitus present with well-known symptoms and signs of hyperglycemia, including polydipsia, polyuria, visual disturbances, fatigue, weight loss. Fewer than one percent of patients present with chronic diarrhea (1). We hereby present a case of uncontrolled DM presenting as chronic diarrhea. Case: A 44-year-old male with history of post-ablative hypothyroidism, class I obesity, vitamin D deficiency reported 4 to 5 months history of increased stool frequency 4-5 times a day and intermittent watery, non-bloody, non-tarry diarrhea 2 times a week. No fever, chills, weight loss, or recent travel. Diarrhea had not improved with a 2-month trial of low FODMAP diet. On the physical exam, height 177cm, weight (wt) 97kg, BMI 30.56 in 11/2023 (wt 98 kg in 4/2023). Laboratory work-up showed wbc 7.4K (4.2-9.2), CRP 0.4 mg/dl, ESR 15mm/hr, TSH 0.943 mcIU/ml (.45-4.5), tTG IgA <2U/ml, deamidated gliadin IgA 6 units (0-19), IgA 159 mcg/dl (90-386), fecal calprotectin 74 mcg/g (0-120), HIV negative, stool H pylori negative. BG 287 mg/dl, A1c 10.2% 11/29/23 (was 5.6% 2020). He was started on insulin glargine and aspart. At the 6-week follow-up, blood glucose improved to 70s to low 100s, and stool frequency improved to 2 times/day and diarrhea had resolved. Discussion: Chronic diarrhea, defined as having 3 or more stools a day for more than 4 weeks, can affect about 10% of patients with diabetes mellitus. Many of these patients have associated conditions such as celiac disease, food intolerance, chronic pancreatitis with pancreatic exocrine insufficiency, bacterial overgrowth, inflammatory bowel disease, bacterial or parasitic infections, or medication adverse side effects. Some studies have attributed diarrhea of unknown causes in patients with DM to autonomic dysfunction (2). Other studies have shown diarrhea may be due to increased colonic transit time and altered intestinal pH rather than autonomic dysfunction (3). Since the underlying cause of diabetic diarrhea is not always clear, empiric symptom treatment may be indicated. Transdermal clonidine may be helpful in controlling diarrhea without causing orthostatic hypotension. In this case, as the stool frequency and diarrhea improved without any other treatment after diabetes control improved, we believe the underlying cause was uncontrolled DM. Conclusion: Uncontrolled DM should be on the differential diagnosis for chronic diarrhea of unclear etiology. References: 1. Miller, LJ. Small intestinal manifestations of diabetes mellitus. The Yale Journal of Biology and Medicine.1983; 56:189-193,1983. 2. Ogbonnaya, KI et al. Diabetic diarrhea. Pathophysiology, diagnosis, and management. Arch Intern Med. 1990; 150:262-267. 3. Sangnes DA et al. Diabetic diarrhea: a study on gastrointestinal motility, pH levels and autonomic function. Journal of Internal Medicine. 2021; 290:1206-1218. Presentation: 6/3/2024