THE YALE JOURNAL OF BIOLOGY AND MEDICINE 56 (1983), 189-193 Small Intestinal Manifestations of Diabetes Mellitus

Diabetic diarrhea and steatorrhea occur predominantly in young adult males who have juvenile-onset diabetes mellitus complicated by neuropathy. The presentation is often severe, with nocturnal or postprandial watery diarrhea and tenesmus. Massive malabsorption of fat may occur; however, malabsorption of other nutrients and generalized wasting are quite rare. Because the symptoms are relatively refractory to treatment, it is important to rule out other, more easily treatable causes of this presentation. Bacterial overgrowth, exocrine pancreatic in-sufficiency, and celiac disease are also associated with diabetes mellitus and can mimic this pro-cess. Although the mechanism of diabetic diarrhea and steatorrhea remains unclear, neuropathy, gastrointestinal motor abnormalities, bacterial overgrowth, and bile acid abnor-malities have been implicated in the pathogenesis. Diabetic diarrhea and steatorrhea, although rare manifestations of diabetes mellitus, attain clinical importance because of their severity and refractory nature. Despite extensive investigation, the pathogenesis of this disorder remains unclear. In 1926, in their discussion of gastric secretion in the diabetic, Bowen and Aaron [1] described ten patients with severe diarrhea. It was not until 1936, however, tha