Month: January 2023

Overview

Diarrhea — loose, watery and possibly more-frequent bowel movements — is a common problem. It may be present alone or be associated with other symptoms, such as nausea, vomiting, abdominal pain or weight loss.

Luckily, diarrhea is usually short-lived, lasting no more than a few days. But when diarrhea lasts beyond a few days into weeks, it usually indicates that there’s another problem — such as irritable bowel syndrome (IBS) or a more serious disorder, including persistent infection, celiac disease or inflammatory bowel disease (IBD).

Symptoms

Signs and symptoms associated with diarrhea (loose, watery stools) may include:

• Abdominal cramps or pain
• Bloating
• Nausea
• Vomiting
• Fever
• Blood in the stool
• Mucus in the stool
• Urgent need to have a bowel movement

When to see a doctor

If you’re an adult, see your doctor if:

• Your diarrhea persists beyond two days with no improvement
• You become dehydrated
• You have severe abdominal or rectal pain
• You have bloody or black stools
• You have a fever above 102 F (39 C)

In children, particularly young children, diarrhea can quickly lead to dehydration. Call your doctor if your child’s diarrhea doesn’t improve within 24 hours or if your child:

• Becomes dehydrated
• Has a fever above 102 F (39 C)
• Has bloody or black stools

Causes

A number of diseases and conditions can cause diarrhea, including:

• Viruses. Viruses that can cause diarrhea include Norwalk virus (also known as norovirus), enteric adenoviruses, astrovirus, cytomegalovirus and viral hepatitis. Rotavirus is a common cause of acute childhood diarrhea. The virus that causes coronavirus disease 2019 (COVID-19) has also been associated with gastrointestinal symptoms, including nausea, vomiting and diarrhea.
• Bacteria and parasites. Exposure to pathogenic bacteria, such as E. coli or parasites through contaminated food or water, leads to diarrhea. When traveling in developing countries, diarrhea caused by bacteria and parasites is often called traveler’s diarrhea. Clostridioides difficile (also known as C. diff) is another type of bacterium that causes diarrhea, and it can occur after a course of antibiotics or during a hospitalization.
• Medications. Many medications, such as antibiotics, can cause diarrhea. Antibiotics alleviate infections by killing bad bacteria, but they also kill good bacteria. This disturbs the natural balance of bacteria in your intestines, leading to diarrhea or a superimposed infection such as C. diff. Other drugs that cause diarrhea are anti-cancer drugs and antacids with magnesium.
• Lactose intolerance. Lactose is a sugar found in milk and other dairy products. People who have difficulty digesting lactose have diarrhea after eating dairy products. Lactose intolerance can increase with age because levels of the enzyme that helps digest lactose drop as you get older.
• Fructose. Fructose is a sugar found naturally in fruits and honey. It’s sometimes added as a sweetener to certain beverages. Fructose can lead to diarrhea in people who have trouble digesting it.
• Artificial sweeteners. Sorbitol, erythritol and mannitol — artificial sweeteners are nonabsorbable sugars found in chewing gum and other sugar-free products — can cause diarrhea in some otherwise healthy people.
• Surgery. Partial intestine or gallbladder removal surgeries can sometimes cause diarrhea.
• Other digestive disorders. Chronic diarrhea has a number of other causes, such as IBS, Crohn’s disease, ulcerative colitis, celiac disease, microscopic colitis and small intestinal bacterial overgrowth (SIBO).

Complications

Diarrhea can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems.

If you have signs of serious dehydration, seek medical help.

Indications of dehydration in adults

These include:

• Excessive thirst
• Dry mouth or skin
• Little or no urination
• Weakness, dizziness or lightheadedness
• Fatigue
• Dark-colored urine

Indications of dehydration in infants and young children

These include:

• Not having a wet diaper in three or more hours
• Dry mouth and tongue
• Fever above 102 F (39 C)
• Crying without tears
• Drowsiness, unresponsiveness or irritability
• Sunken appearance to the abdomen, eyes or cheeks

Prevention

Preventing infectious diarrhea

Wash your hands to prevent the spread of infectious diarrhea. To ensure adequate hand-washing:

• Wash frequently. Wash your hands before and after preparing food. Wash your hands after handling uncooked meat, using the toilet, changing diapers, sneezing, coughing and blowing your nose.
• Lather with soap for at least 20 seconds. After putting soap on your hands, rub your hands together for at least 20 seconds. This is about as long as it takes to sing “Happy Birthday” twice through.
• Use hand sanitizer when washing isn’t possible. Use an alcohol-based hand sanitizer when you can’t get to a sink. Apply the hand sanitizer as you would hand lotion, making sure to cover the fronts and backs of both hands. Use a product that contains at least 60% alcohol.

Vaccination

You can help protect your infant from rotavirus, the most common cause of viral diarrhea in children, with one of two approved vaccines. Ask your baby’s doctor about having your baby vaccinated.

Preventing traveler’s diarrhea

Diarrhea commonly affects people who travel to countries where there’s inadequate sanitation and contaminated food. To reduce your risk:

• Watch what you eat. Eat hot, well-cooked foods. Avoid raw fruits and vegetables unless you can peel them yourself. Also avoid raw or undercooked meats and dairy foods.
• Watch what you drink. Drink bottled water, soda, beer or wine served in its original container. Avoid tap water and ice cubes. Use bottled water even for brushing your teeth. Keep your mouth closed while you shower.Beverages made with boiled water, such as coffee and tea, are probably safe. Remember that alcohol and caffeine can aggravate diarrhea and worsen dehydration.
• Ask your doctor about antibiotics. If you’re traveling to a developing country for an extended time, ask your doctor about antibiotics before you go, especially if you have a weakened immune system.
• Check for travel warnings. The Centers for Disease Control and Prevention maintains a travelers’ health website where disease warnings are posted for various countries. If you’re planning to travel outside of the United States, check there for warnings and tips for reducing your risk.

Coronaviruses are a family of viruses that can cause respiratory illness in humans. They are called “corona” because of crown-like spikes on the surface of the virus. Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the common cold are examples of coronaviruses that cause illness in humans.

The new strain of coronavirus — SARS-CoV-2 — was first reported in Wuhan, China in December 2019. It has since spread to every country around the world.

Where do coronaviruses come from?

Coronaviruses are often found in bats, cats and camels. The viruses live in but don’t infect the animals. Sometimes these viruses then spread to different animal species. The viruses may change (mutate) as they transfer to other species. Eventually, the virus can jump from animal species and begin to infect humans. In the case of SARS-CoV-19, the first people infected are thought to have contracted the virus at a food market that sold meat, fish and live animals.

How do you get COVID-19?

SARS-CoV-2, the virus that causes COVID-19, enters your body through your mouth, nose or eyes (directly from the airborne droplets or from the transfer of the virus from your hands to your face). It then travels to the back of your nasal passages and mucous membrane in the back of your throat. It attaches to cells there, begins to multiply and moves into lung tissue. From there, the virus can spread to other body tissues.

How does the new coronavirus (SARS-CoV-2) spread from person to person?

Coronavirus is likely spread:

• The virus travels in respiratory droplets released into the air when an infected person coughs, sneezes, talks, sings or breathes near you. You may be infected if you inhale these droplets.
• You can also get coronavirus from close contact (touching, shaking hands) with an infected person and then touching your face.

How long is a person with COVID-19 considered contagious?

If you have COVID-19 it can take several days to develop symptoms — but you’re contagious during this time. You are no longer contagious 10 days after your symptoms began.

The best way to avoid spreading COVID-19 to others is to:

• Stay 6 feet away from others whenever possible.
• Wear a cloth mask that covers your mouth and nose when around others.
• Wash your hands often. If soap isn’t available, use a hand sanitizer that contains at least 60% alcohol.
• Avoid crowded indoor spaces. Open windows to bring in outdoor air as much as possible.
• Stay self-isolated at home if you are feeling ill with symptoms that could be COVID-19 or have a positive test for COVID-19.
• Clean and disinfect frequently touched surfaces.

Who’s most at risk for getting COVID-19?

Persons at greatest risk of contracting COVID-19 include those who:

• Live in or have recently traveled to any area with ongoing active spread.
• Have had close contact with a person who has a laboratory-confirmed or a suspected case of the COVID-19 virus. Close contact is defined as being within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period.
• Are over the age of 60 with pre-existing medical conditions or a weakened immune system.

How soon after becoming infected with SARS-CoV-2 will I develop COVID-19 symptoms?

The time between becoming infected and showing symptoms (incubation period) can range from two to 14 days. The average time before experiencing symptoms is five days. Symptoms can range in severity from very mild to severe. In about 80% of people, COVID-19 causes only mild symptoms, although this may change as variants emerge.

If I recover from a case of COVID-19, can I be infected again?

If you test positive for SARS-CoV-2 three months after your last positive test, it’s considered a reinfection. Before the omicron variant, reinfection with SARS-CoV-2 was rare but possible.

Omicron (B.1.1.529) was first reported in South Africa in November 2021 and quickly spread around the world. With many mutations, omicron was able to evade immune systems and we had more reinfections than ever before.

As the virus that causes COVID-19 continues to mutate, reinfection remains possible. Vaccination — including a booster dose — is the best protection against severe disease.

SYMPTOMS AND CAUSES

What are the symptoms of COVID-19?

COVID-19 symptoms vary from person to person. In fact, some infected people don’t develop any symptoms (asymptomatic). In general, people with COVID-19 report some of the following symptoms:

• Fever or chills.
• Cough.
• Shortness of breath or difficulty breathing.
• Tiredness.
• Muscle or body aches.
• Headaches.
• New loss of taste or smell.
• Sore throat.
• Congestion or runny nose.
• Nauseaor vomiting.
• Diarrhea .

Additional symptoms are possible.

Symptoms may appear two to 14 days after exposure to the virus. Children have similar, but usually milder, symptoms than adults. Older adults and people who have severe underlying medical conditions are at higher risk of more serious complication from COVID-19.

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Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It’s also the brain’s main source of fuel.

The main cause of diabetes varies by type. But no matter what type of diabetes you have, it can lead to excess sugar in the blood. Too much sugar in the blood can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes happens when blood sugar levels are higher than normal. But the blood sugar levels aren’t high enough to be called diabetes. And prediabetes can lead to diabetes unless steps are taken to prevent it. Gestational diabetes happens during pregnancy. But it may go away after the baby is born.

Symptoms
Diabetes symptoms depend on how high your blood sugar is. Some people, especially if they have prediabetes or type 2 diabetes, may not have symptoms. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the symptoms of type 1 diabetes and type 2 diabetes are:

Feeling more thirsty than usual.
Urinating often.
Losing weight without trying.
Presence of ketones in the urine. Ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin.
Feeling tired and weak.
Feeling irritable or having other mood changes.
Having blurry vision.
Having slow-healing sores.
Getting a lot of infections, such as gum, skin and vaginal infections.
Type 1 diabetes can start at any age. But it often starts during childhood or teen years. Type 2 diabetes, the more common type, can develop at any age. Type 2 diabetes is more common in people older than 40.

When to see a doctor
If you think you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your health care provider. The earlier the condition is diagnosed, the sooner treatment can begin.
If you’ve already been diagnosed with diabetes. After you receive your diagnosis, you’ll need close medical follow-up until your blood sugar levels stabilize.

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Insulin is a chemical messenger that allows cells to absorb glucose, a sugar, from the blood.

The pancreas is an organ behind the stomach that is the main source of insulin in the body. Clusters of cells in the pancreas called islets produce the hormone and determine the amount based on blood glucose levels in the body.

The higher the level of glucose, the more insulin goes into production to balance sugar levels in the blood.

Insulin also assists in breaking down fats or proteins for energy.

A delicate balance of insulin regulates blood sugar and many processes in the body. If insulin levels are too low or high, excessively high or low blood sugar can start to cause symptoms. If a state of low or high blood sugar continues, serious health problems might start to develop.

Insulin problems

In some people, the immune system attacks the islets, and they cease to produce insulin or do not produce enough.

When this occurs, blood glucose stays in the blood and cells cannot absorb them to convert the sugars into energy.

This is the onset of type 1 diabetese, and a person with this version of diabetes will need regular shots of insulin to survive.

In some people, especially those who are overweight, obese, or inactive, insulin is not effective in transporting glucose into the cells and unable to fulfill its actions. The inability of insulin to exert its effect on tissues is called insulin resistance.

Type 2 diabetese will develop when the islets cannot produce enough insulin to overcome insulin resistance.

Since the early 20th century, doctors have been able to isolate insulin and provide it in an injectable form to supplement the hormone for people who cannot produce it themselves or have increased insulin resistance.

Types of Insulin

A person can take different.types of insulin based on how long they need the effects of the supplementary hormone to last.

People categorize these types based on several different factors:

• speed of onset, or how quickly a person taking insulin can expect the effects to start.
• peak, or the speed at which the insulin reaches its greatest impact
• duration, or the time it takes for the insulin to wear off
• concentration, which in the United States is 100 units per milliliter (U100)
• the route of delivery, or whether the insulin requires injection under the skin,into a vein, or into the lungs by inhalation.

People most often deliver insulin into the subcutaneous tissue, or the fatty tissue located near the surface of the skin.

Three main groups of insulin are available.

Fast-acting insulin

The body absorbs this type into the bloodstream from the subcutaneous tissue extremely quickly.

People use fast-acting insulin to correct hyperglycemia, or high blood sugar, as well as control blood sugar spikes after eating.

This type includes:

• Rapid-acting insulin analogs: These take between 5 and 15 minutes to have an effect. However, the size of the dose impacts the duration of the effect. Assuming that rapid-acting insulin analogs last for 4 hours is a safe general rule.
• Regular human insulin: The onset of regular human insulin is between 30 minutes and an hour, and its effects on blood sugar last around 8 hours. A larger dose speeds up the onset but also delay the peak effect of regular human insulin.

Intermediate-acting insulin

This type enters the bloodstream at a slower rate but has a longer-lasting effect. It is most effective at managing blood sugar overnight, as well as between meals.

Options for intermediate-acting insulin include:

• NPH human insulin: This takes between 1 and 2 hours to onset, and reaches its peak within 4 to 6 hours. It can last over 12 hours in some cases. A very small dose will bring forward the peak effect, and a high dose will increase the time NPH takes to reach its peak and the overall duration of its effect.
• Pre-mixed insulin: This is a mixture of NPH with a fast-acting insulin, and its effects are a combination of the intermediate- and rapid-acting insulins.

Long-acting insulin

While long-acting insulin is slow to reach the bloodstream and has a relatively low peak, it has a stabilizing “plateau” effect on blood sugar that can last for most of the day.

It is useful overnight, between meals, and during fasts.

Long-acting insulin analogs are the only available type, and these have an onset of between 1.5 and 2 hours. While different brands have different durations, they range between 12 and 24 hours in total.

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