Q. What is the cause of my symptoms, diabetes or Crohn's disease?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 11, 2020 and last reviewed on: Jul 08, 2021

Hi doctor,

I am a 22-year-old male with a weight of 68 kilograms and a height of five feet seven inches. I do not smoke, drink or use any recreational drugs. I have some pre-existing medical issues for several years like acne, anal itching or jock itch, stomach cramps after eating, and an urge to defecate or urinate almost right away. I do not take any medications. In the recent 12 months, I am losing weight quickly without any effort and I have lost appetite. I did not do any work by doing cycling or walking. I have abdominal pain originating from the abdomen and gets extended to the back sometimes. I also have frequent urination. My urine remains dark brownish.

When I flush it, I can see bubbles and it appears foamy. I also had a white tongue and I figured it out as oral thrush. I had some brown spots on my ankles and chins. Sometimes, they cause itching and I thought of it was diabetic dermopathy. I had alternating periods with loose, porridge-like fatty stools or diarrhea in light yellow or brown or orange color. Sometimes, my breath smells funny. I am not sure whether it smells like ammonia or ketone or halitosis. Sometimes, it smells like urine or rotten things. I searched online and got a result of type 2 diabetes. I thought that I need to have a reasonable explanation. So I decided to consult a doctor in the clinic.

After getting advice from my physician, I did a blood test and HIV test to rule out the cause. I did my blood test after fasting for 12 hours ans my Hba1c was 5.2% and my fasting glucose was 4.3 mmol/L. The only test that remained high was my bilirubin levels. The doctor told me that it is mostly like to be IBD or IBS. He told me to have a food diary and told me to note foods that upset my stomach. Again, I consulted my physician after few days to do an abdomen ultrasound to check my liver. My results came back normal. I consulted the doctor again after few days and he told me to do a urine analysis.

All my parameters were normal except erythrocytes with a range of 0.3 mg/L. A note on the result showed that it was on borderline to predict hematuria. In general chemistry, the total protein was 78 g/L (reference is 60 to 80), and albumin was 50 g/L (reference is 35 to 52). I feel this is very close to being high. Apart from this, in the random urine chemistry section, my ACR was reported. The albumin (urine) was at 13 mg/L, and creatinine (urine) was high at 34 mmol/L (reference was 3.5 to 24.5). Finally, the ACR ratio was 0.4 mg/mmol. I got anxious and searched online about the cause of having high creatinine in urine.

My results pointed towards diabetes, muscle composition, and kidney problems. I reached out today morning again to a doctor to ask the cause of my issue based on the blood test, ultrasound, and urine test. The doctor was quick to dismiss my concerns. He told me that my symptoms mean COVID-19 and told me to have self-isolation. I gave up at this point and was not sure of what I should do. My guesses are IBS or IBD (Crohn's or ulcerative colitis), diabetes, and celiac disease. I have never been tested for this and I am pretty tolerant to gluten foods. I have lactose intolerance as drinking dairy products causes an upset stomach usually.

Kindly help me. Let me know what I should do about the anal itching or jock itch and for the weird smell on my tongue. My doctor told me it must be due to bacteria and told me to use salt water to gargle previously. Any advice regarding this situation would be appreciated. I appreciate any help that you provide.



Welcome to

You have explained your symptoms well. It was palatable to read. Well, your concerns are genuine but here is my take on this. You are too young to develop type 2 diabetes mellitus and dermatopathy. It is far away to be even considered. You have a normal glucose level with HBA1c (glycated hemoglobin). So no point to linger with this diagnosis anymore. Lactose intolerance occurs commonly in almost 65% of the adult population because the enzyme lactase gets low in amount as age advances. The best option is to avoid milk and milk-based things. Celiac is a possibility and it should be reasonably excluded by doing a simple blood test. Crohn's disease is a possibility especially in young aged people with abdominal pain and unusual weight loss. I suggest you do stool testing, to know whether it is present in you or not. I cannot figure out what is the cause in you to have oral thrush. You probably have gone through the reasons underlying thrush. It occurs commonly in immunocompromised individuals. Merely weight loss does not make you immunocompromised. Share a photo of your oral cavity by sitting in the front mirror and share a photo of a skin pigmentation picture. It can help me to guide you further. At last, IBS confirms your symptoms. So for me, it is early to say IBS (irritable bowel syndrome). Find investigations below. If you have concerns, you can reach out to me here.

Investigations to be done:

Do anti TTG (tissue transglutaminase) IgA and IgG, serum IgA (immunoglobulin A) levels, serum IgE (immunoglobulin E), CRP (C-reaction protein), and ESR (erythrocyte sedimentation rate), stool detail report, and stool for fecal calprotectin.

Regarding follow up:

Have a follow-up with above investigations.

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