Glipicide user, 5 mg. Take prior to eating

Answer by Dr. Albana Greca, MD, MMedSc

Hello,

I read your message carefully, and I understand how upsetting and limiting this problem has become for you. Frequent diarrhea, stomach pain, and fear of having an accident can strongly affect daily life, travel, social activities, and emotional well-being.

First, the medicine name is glipizide, not “glipicide.” Glipizide belongs to a group of diabetes medicines called sulfonylureas. It helps the pancreas release more insulin, so it is usually taken before a meal as prescribed by your doctor.

Could Glipizide Be Causing the Diarrhea?

Yes, it is possible. Diarrhea is a known possible side effect of glipizide, although it is more commonly associated with metformin. Because your diarrhea improved after stopping metformin but later returned after using glipizide, your medication should be reviewed again by your diabetes doctor.

However, it is important not to assume that the medicine is the only cause. Ongoing or severe diarrhea can also come from other problems, including irritable bowel syndrome, infection, food intolerance, gallbladder-related bile acid diarrhea, thyroid disease, pancreatic enzyme problems, inflammatory bowel disease, microscopic colitis, diabetic autonomic neuropathy, or other medicines and supplements.

Do Not Stop Diabetes Medicine on Your Own

Please do not stop glipizide suddenly without speaking with your doctor, because your blood sugar may rise. Instead, contact your doctor and explain clearly that the diarrhea is affecting your quality of life and that you need a safer long-term plan.

Your doctor may consider changing the dose, changing the timing, switching to another diabetes medicine, or checking whether you still need this type of medicine. The best choice depends on your HbA1c, kidney function, weight, heart history, risk of low blood sugar, and other health conditions.

One Meal a Day Can Be Risky With Glipizide

Because glipizide increases insulin release, eating only one meal a day may increase your risk of low blood sugar, especially if you take the medicine and then eat very little. Please discuss your eating pattern with your doctor. You may need a medication plan that better matches your meals and daily routine.

What About Imodium?

Imodium may help control diarrhea for some people, and your gastroenterologist has advised it when bouts occur. But it is still important to find the cause of the diarrhea rather than only controlling the symptom.

Do not use anti-diarrhea medicine without medical advice if you have fever, blood in the stool, black stools, severe abdominal pain, dehydration, unexplained weight loss, or diarrhea after antibiotics, because these signs may need urgent evaluation.

Weak Sphincter Muscle: Is There Treatment?

Yes. A weak anal sphincter can cause bowel leakage or accidents, but treatment is possible. Depending on the cause and severity, treatment may include:

• Pelvic floor exercises


• Biofeedback therapy


• Bowel training


• Diet changes and fiber adjustment


• Medicines to reduce loose stools


• Evaluation by a colorectal specialist


• Procedures or surgery in selected cases

If you have not already done so, ask your gastroenterologist whether you need anorectal manometry, pelvic floor testing, stool tests, or referral to a pelvic floor therapist or colorectal specialist.

Why Am I Told I Am Insulin Resistant?

In type 2 diabetes, the pancreas may still make insulin, especially in the earlier years. The problem is that the body’s cells do not respond to insulin normally. This is called insulin resistance.

Over time, the pancreas may become tired and may not produce enough insulin to keep blood sugar controlled. This is why some people with type 2 diabetes need medicine that helps insulin work better, medicine that helps the pancreas release insulin, or sometimes insulin treatment.

What I Recommend You Discuss With Your Doctor

• Whether glipizide may be contributing to your diarrhea


• Whether another diabetes medicine would be safer for you


• Your HbA1c and blood sugar pattern


• Your kidney and liver function


• Your risk of low blood sugar, especially because you eat one meal a day


• Stool tests or further bowel evaluation if diarrhea continues


• Testing for thyroid disease, vitamin B12 deficiency, celiac disease, pancreatic enzyme problems, or microscopic colitis if appropriate


• Treatment options for weak sphincter muscle and bowel leakage