A clinical case of severe type 1 diabetes mellitus with suspected neuroendocrine tumor (VIPoma)

Aim. To present a clinical case of observation and treatment of a patient with type 1 diabetes mellitus and suspected pancreatic neuroendocrine tumor (clinically VIPoma). Materials and Methods. Description of a clinical case of severe type 1 diabetes mellitus. Results. The gastrointestinal form of diabetic autonomic neuropathy is manifested by hypo- and atony of the esophagus (in 2-27% of patients with diabetes) and stomach (7-29%), intestinal hypomotility, diarrhea (0-22%), gallbladder atony and biliary dyskinesia with a tendency to cholelithiasis and reactive pancreatitis. There is a direct relationship between the incidence of diabetic autonomic neuropathy and the duration and degree of compensation of diabetes. Diabetic diarrhea results from impaired innervation, bacterial overgrowth syndrome, pancreatic insufficiency, bile acid metabolism disorders due to biliary dyskinesia, impaired colonic motility, anorectal dysfunction, microangiopathy and atrophy of the intestinal mucosa, and vitamin deficiency. The prevalence of diarrhea in patients with diabetes ranges from 4% to 22%. In 20-44% of cases, diabetic diarrhea associated with autonomic gastropathy may alternate with constipation. Timely treatment of gastrointestinal complications of diabetes can increase the active life expectancy of patients. The primary goals of diabetic gastropathy therapy are glycemic control and reduction of dyspeptic symptoms. Glycemic control is crucial in preventing the development of autonomic gastropathy. Conclusion. Patients with diabetes mellitus should achieve target carbohydrate metabolism values and avoid hypoglycemia to prevent the development of diabetic complications. Autonomic gastropathy presents challenges in patient management for the practitioner and significantly reduces the patient's quality of life. A neuroendocrine tumor (VIPoma) may be suspected in the presence of prolonged intermittent diarrhea.