Natural Treatment to get rid of Flatulence
Chiasson and colleagues in Montreal conducted a small pilot study (n 18) of acarbose, an alpha-glucosidase inhibitor215, in people with IGT222. Acarbose delays intestinal absorption of glucose and lowers peak glucose and insulin levels after eating. After four months, subjects on acarbose showed lower post-meal and 12 h glucose and insulin profiles, with no change among those on placebo. During an insulin suppression test, post-treatment steady-state glucose levels were significantly lower at the same level of insulin, suggesting improved insulin sensitivity. No changes in BMI, HDL cholesterol or triglycerides, fasting glucose or insulin, HbA1c or BP were seen in either group. No comments were made concerning the side effects of acarbose, which is known to include increased flatulence and diarrhea215. Results in this short-term study suggest the utility of acarbose to improve glucose tolerance and insulin sensitivity, and led the authors to begin the STOP-NIDDM multicenter trial223 in...
From the recordings of her daily measurements, it is deduced that her DM is very unstable. All measurements range between 30mg dl (1.67mmol L) and 450mg dl (25.0mmol L) and no relation can be found between the units of consumed carbohydrates and the units of the insulin analogue injected before each meal. The patient reports that she was never able to control her blood sugar. Furthermore, she complains of severe gastroparesis symptoms and intense flatulence, which impede every effort to control her blood sugar, despite the use of prokinetic gastrointestinal medicines. A recent gastroscopy reveals bile-stained fluids in the stomach and food residuals, atrophy of the gastric and the duodenal mucosa and first degree oesophagitis in the distal part of the oesophagus. In the past she tried to manage the
A-Glucosidase inhibitors should be taken with the first bite of food. Gastrointestinal effects of bloating, flatulence, diarrhea, and stomach pain can occur early in therapy and diminish with time. These agents are ideally suited for those patients who ingest significant amounts of complex carbohydrates as adjunctive therapy to sulfonylureas and insulin sensitizers. Although they work on two different mechanisms in controlling postprandial sugar, sufficient data does not yet exist to give a formal recommendation on concomitant use of a-glucosidase inhibitors and glinides (5).
What is the fate of undigested carbohydrates and what undesirable effects can be produced by their presence in the
Undigested carbohydrates are removed with the stool. However, in the large intestine, the normal intestinal flora causes fermentation of the redundant carbohydrates and local excessive production of the products of this fermentation (lactic acid, hydrogen, carbon dioxide, etc.). As a consequence, those substances that are not absorbed cause flatulence, abdominal aches, diarrhoea or excessive production of gases. To some degree these complaints can be avoided with progressive increase of the dose and they generally subside completely after the first weeks or months. However, if a large quantity of sugar is consumed and the recommended diet it is not followed, the diarrhoea can be intense.
Acarbose is contraindicated in pregnant and nursing women and when there are chronic intestinal diseases with definite disturbance in digestion and absorption. Great caution should be exercised when the patient has large hernias as well as ulcers or stenoses of the intestine. Individuals with constipation due to DM should better avoid the intake of acarbose, because the neuropathy of the autonomous nervous system that causes constipation can intensify flatulence and abdominal aches.
How do you manage a patient with findings of severe peripheral diabetic neuropathy but without symptoms
The most probable diagnosis is gastroparesis. It occurs both in Type 1 and Type 2 diabetic persons and is one of the most severe diabetic complications, because it adversely affects metabolic control and quality of life. It is not, however, associated with other complications or with higher mortality. Gastroparesis can also occur acutely, in cases of diabetic ketoacidosis, but in that case is reversible. It is due to a combination of disturbances (decrease in intensity of gastric muscular contractions, lack of synchronization between gastric and duodenal motility, pyloric spasm) owing to damage of the gastric pacemaker at the fundus of the stomach that regulates motility. Gastroparesis symptoms are morning nausea, burping, flatulence, epigastric pain, early satiety and post-prandial vomiting. The most characteristic symptom of gastroparesis is vomiting of undigested food consumed several hours prior (8-12 hours) or even days before. Symptoms can have exacerbations and remissions or...
Gastrointestinal side effects frequently noted by patients are meteorism, flatulence, diarrhea (Table 4) or simple abdominal discomfort (7). Gastrointestinal complaints exhibit strong interindividual and regional differences, depending on nutrition habits, diet compliance, and advice from medical staff. During the first weeks of treatment, and within the first 3 months, the enzyme content of the lower part of the small intestine increases and most of the carbohydrates reaching this part of the bowel can be digested here. This is indicated by a decrease in gastrointestinal side effects to 10 in long-term follow-up studies (26). No malabsorption of carbohydrates is observed, together with fermentative digestion of carbohydrates in the colon. Thus, weight remains nearly unchanged, with a maximal weight loss of 0.7 to 0.9 kg in long-term follow-up studies (26,40). Gastrointestinal side effects diminish after 4 to 6 weeks (Fig. 4) (48), as has been consistently shown in controlled studies....
In the UKPDS, glibenclamide as well as insulin therapy induced a weight gain of 4.8 kg, whereas the intake of acarbose (probably through reduction of hyperinsulinemia) was associated with a mild weight loss (0.7 kg after 1 year follow-up). Acarbose also has the advantage that it does not cause hypoglycemia, being an antidiabetic rather than a hypoglycemic agent. It is well tolerated in the dose range of 25-250 mg t.i.d., but small doses (from 25 to 50 mg t.i.d.) can also be effective and cause only fewer gastrointestinal side effects. The latter include meteorism, flatulence, nausea, borborygmus, diarrhea and abdominal cramps or distension. The frequency of gastrointestinal complaints is not related to the acarbose dose and decreases over time. Adaptation of intestinal enzyme activity may account for the diminution of intestinal side
A-Glucosidase inhibitors are modestly effective in treating diabetes with hemoglobin A1-C reductions of 0.5-1 and can be particularly effective in patients who consume high-carbohydrate diets. Adverse effects of a-glucosidase inhibitors are gastrointestinal and include abdominal bloating, pain, diarrhea, and flatulence, occurring in up to 70 of patients. Although these adverse effects tend to dissipate in 4-6 weeks, they are to be a major reason for discontinuation of medications.
When AGIs are given orally, they reduce the digestion of carbohydrates in the upper half of the small intestine, so that a larger proportion is digested in the lower part and in the colon (Fig. 2). The rise in postprandial hyperglycemia is immediately diminished when AGIs are taken with the first bites of a meal (20). The amount of carbohydrate reaching the colon, and the alpha-glucosidase activity in the lower small intestine, determines the frequency and severity of gastrointestinal side effects, such as meteorism, flatulence, and diarrhea, due to fermentation gases and short-chain fatty acids (21). The quantity of undigested carbohydrates reaching the colon can be determined by measurement of breath hydrogen. The therapeutic effects, as well as side effects, therefore strongly depend on the amount and type of carbohydrates in the diet. It has been shown that acarbose is more effective in a diet rich in starch, because it has its strongest effect on glucoamylase (22).
Alpha-glucosidase inhibitors (AGI), including miglitol and acarbose, work by inhibiting enzymatic degradation of complex carbohydrates, thus slowing their intestinal absorption. The effect of AGI is essentially limited to reduction of postprandial hyperglycemia, but this may be sufficient for some older patients with mild diabetes. However, many older patients are intolerant to the gastrointestinal side effects (bloating, flatulence), which may limit the drug's usefulness. AGIs have also been reported to reduce the development of diabetes in a middle-aged high-risk population with IGT (60), but effectiveness among older patients has not been reported.
Gastrointestinal side-effects are common. Because acarbose interferes with carbohydrate metabolism, fermentation is increased and this can cause bloating, flatulence, and diarrhoea. The symptoms are worse if patients eat sugar. If acarbose is given to patients on sulphonylureas they must be warned
The use of pharmacologic agents to reduce weight is not indicated in children until more safety and efficacy data become available (72). Orlistat, which interferes with with fat absorption, has been approved for use in children but is an unpopular choice because it causes flatulence and fecal soilage (73). Metformin has been tested in a six-month randomized placebo-controlled study of 29 black and white adolescents 12 to 19 years of age who had BMI 30 kg m2, type 2 diabetes family history, elevated fasting insulin and no biochemical evidence of diabetes (74). In this small study, there was less increase of BMI in those taking metformin, with a decrease in FPG and insulin levels. In adults, lifestyle intervention has been more effective than metformin in preventing progression from IGT to diabetes (75). Sibutramine, a central appetite regulator, while popular for weight control treatment of adults, has not been tested in children, nor have long-term studies assessed the effects on...