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Q. What could be the reason for chronic diarrhea with tapeworms in a diabetic?

Answered by
Dr. Arbab Muhammad Kashif Khan
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 09, 2020 and last reviewed on: Jun 20, 2020

Hello doctor,

I am a type 1 diabetic and I suffered chronic diarrhea for the past 10 years. Finally, the doctor found tape worms, and eggs in the stool. I had several rounds of praziquantel, last round was 2 weeks ago with 650 mg per day with a break in between. I took supplements of all kinds, and now colonics. I am still passing worms. I have improvements in health, pain, and girth around my stomach also improved but I am frustrated. I cannot seem to get rid of it. Please help.

#

Hello,

Welcome to icliniq.com.

I suppose you must give a brief history of the nature of your diarrhea. Like mostly it is oily and malodorous, watery or gassy? Does it have any relation to meals? Do you feel any abdominal pain, fever, or itching at the anal area? Do you ever have a low Hb? Any loss of weight? What type of worms did you notice on the stool R/E report? And most importantly, is your diabetes controlled?


The Probable causes:

Worm infestation.

Investigations to be done:

Complete blood count.
Stool routine examination.

Differential diagnosis:

Diabetic diarrhea.

Treatment plan:

Drink boiled water (after cooling). Personal hand hygiene. Sugar control. Tablet Albendazole 200 mg (two tablets now).

Preventive measures:

Personal hygiene.

Thank you doctor,

I have been diabetic for 30 years. My HbA1c is always around 6 but elevated in the past year with digestion changes now that I am absorbing more food. I take the low carb and low sugar diet, organic, and whole food base. I cook and eat Mediterranean dishes. I am aware of diabetic diarrhea. I know I have gastroparesis and it is making tapeworm infection worse. My stool is watery, malodorous and gassy and it happens 3-10 times a day. Sometimes I have bloating and water retention and I eat low fodmap. What I eat at dinner is clearly out by noon the next day. My stomach is always achy and painful. Some anal itching usually occurs at night or after diarrhea. My iron levels are up after much work. The type of tapeworm is Dipylidium though I never had pets. We eat a lot of fresh fish out of the ocean but not sure of the source.

#

Hello,

Welcome back to icliniq.com.

You have a history of tape worms and you have already tried Praziquantel according to your history, I must suggest Albendazole 400 mg per day for three days. You also have some symptoms related to your diabetes (small intestinal bacterial overgrowth) so it is better to add another drug known as Rifaximine.


The Probable causes:

Worm infestation.

Investigations to be done:

Lactose hydrogen breath test.

Differential diagnosis:

Small intestinal bacterial overgrowth (SIBO).

Treatment plan:

Tablet Albendazole 200 mg twice daily for three days, Rifaximine 550 mg twice a day for 10 days.

Preventive measures:

Take well cooked meals. Personal hygiene. Clean drinking water. Take peeled off fruits.


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