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Changes in the Intestine - Complications of Diabetes 1

coma, intestinal and frequent


1. most cases of diabetes the bowels are regular, or at most there is a slight tendency to constipation. A loose action of the bowels is not common, although it may be observed. Some patients have one or two thin pasty evacuations daily, and feel very well in consequence.

2. Intestinal Catarrh and its Relation to Coma.—The case is very dif ferent when frequent attacks of diarrhoea occur in consequence of acute intestinal catarrh. Every acute catarrh of the intestine is a matter of serious moment for the diabetic. In the first place it interferes with the nourishment, forbidding especially the ingestion of any large quantity of fat, and secondly, experience has shown that diabetic coma is a frequent sequel of acute catarrhal enteritis. The views as to the relation which these two conditions bear to each other are various. Authors differ as to whether (a) the diarrhoea is simply the first symptom, a precursor, of the threatening coma, or (1)) the toxic sub stances formed in the intestinal canal during a catarrhal attack are absorbed and induce coma, or finally (c) the coma is merely a result of the general depression and interference with nutrition associated with catarrhal enteritis. I myself incline to the last-mentioned the

ory. But whatever the relation may be, diarrhoea is by no means a necessary accompaniment of diabetic coma, for it is absent in at least fifty per cent. of the cases.

On the other hand we must regard obstinate and long-continued constipation with suspicion. Schmitz in particular has drawn atten tion to the fact that coma is a frequent sequel to this condition, He believes that dangerous poisons may be resorbed from the stagnating contents of the bowel, and utters an urgent warning against allowing the bowels to remain constipated in cases of diabetes.

3. Steatorrhoea (Fatty Stools).—Wheuever in cases of diabetes the feces contain much fat, as may happen in disorders of the pancreatic secretion and in stoppage of the biliary passages, the stools become very frequent, are pulpy, of a dirty gray color, and of putrid odor (cf. p. 84).

4. Anatomical changes i» the intestinal walls are very seldom met with. In a few cases here and there catarrhal lesions of the mucous coat and brown atrophy of the muscularis have been observed.