Severe decompensation of diabetes can be accompanied by the development of anorexia and nausea. With ketoacidosis, vomiting joins, sometimes abdominal pain. Less commonly, hemorrhagic diathesis with gastrointestinal bleeding (vomiting of coffee grounds) and an “acute abdomen” with peritoneal phenomena develops. However, with a prolonged course of diabetes and outside the state of acidosis, gastric complaints, stool disorders (tendency to constipation and diarrhea), periodically abdominal pain with localization in the epigastric region or along the large intestines are often observed.
Gastrointestinal issues are caused by impaired motility in the presence of damage to the autonomic nervous system, a decrease in the acid-forming and enzymatic functions of the stomach, inhibition of activity and production of intestinal hormones as a result of atrophic changes in the mucous membrane of the stomach and intestines, changes in intestinal microflora, impaired intestinal absorption and parietal digestion.
Severe decompensation of diabetes can be accompanied by the development of anorexia.
The described changes cause frequent development in patients with gastroduodenitis, hypotension and dilatation of the stomach, chronic gastritis and colitis. With recent diabetes in young patients with decompensation of the disease, especially with ketonemia, increased acidity of gastric juice may be observed.
A debilitating manifestation of gastrointestinal upsets is diabetic enteropathy. In addition to the usual dyspeptic symptoms associated with chronic gastritis or colitis, persistent diarrhea develops. In severe cases, the frequency of stool reaches 20-30 times a day, night diarrhea is characteristic, which can be accompanied by fecal incontinence. Significant weight loss is observed. In some patients, the development of diabetic enteropathy with peripheral polyneuropathy is accompanied by a syndrome of diabetic neuropathic cachexia. Diabetic enteropathy develops with prolonged decompensated diabetes and is a manifestation of disorders of the autonomic nervous system.
In most patients, in addition to symptoms of diabetic neuropathy with damage to the autonomic nerve nodes, steatorrhea is observed, indicating a change in the exocrine pancreatic function. With enteropathy, along with these leading causes, the role of damage to the small vessels of the intestines, atrophy of the small intestine mucosa, changes in the intestinal microflora, impaired activity and secretion of intestinal hormones cannot be ruled out.
In 10-15% of patients disorders are not eliminated after achieving compensation for diabetes
Decompensated diabetes leads to damage to the hepatobiliary system with impaired functional state of parenchymal cells, biliary and biliary functions. Diabetic damage to the liver is primarily associated with fatty infiltration caused by insulin deficiency, glycogen depletion of the liver, increased peripheral lipolysis, mobilization of fatty acids from adipose tissue and their increased transport to the liver. Long-existing fatty infiltration may be accompanied by the development of cirrhotic changes. Parenchymal changes are exacerbated by the phenomena of dyskinesia, expansion of the gallbladder due to diabetic visceral neuropathy. Clinically, hepatobiliary disorders are accompanied by an increase and soreness of the liver and gall bladder, visible mucous membranes and sclera. Patients complain of a feeling of heaviness and pain in the right hypochondrium. Long-term and pronounced changes are accompanied by a violation of the protein-forming, excretory antitoxic and enzymatic functions of the liver.
In 10-15% of patients, these disorders are not eliminated after achieving compensation for diabetes, which allows them to diagnose diabetic hepatitis or hepatopathy. In children, the combination of hepatomegaly with a delay in sexual and physical development with a somewhat excessive deposition of fat according to the Cushingoid type is called Mauriac’s syndrome. A rarer form of this disease in children with reduced body weight is Mauriac’s syndrome.
Cholestasis, a violation of the functional state of the liver, often combined with obesity, often lead to the development of diabetes mellitus, cholecystitis and gallstone disease in patients.