can insulin cause diarrhea

Long-term studies suggest the drug may reduce the risk of some cancers. If the underlying cause is bacterial overgrowth, treatment will aim to reduce the number of bacteria in the body and allow healing time. Diabetic gastroparesis prevents the stomach from emptying its contents at a normal speed, causing a variety of symptoms, including abdominal pain, nausea, vomiting, and feelings of fullness early during a meal. Pour a small amount of a sugar solution (eg, corn syrup) onto your finger and then rub the sugar solution onto your pet's gums. Symptoms include: hunger, sweating, irritability, trouble concentrating, rapid breathing, fast heartbeat, seizure (severe hypoglycemia can be fatal). A doctor can also prescribe medications, such as loperamide (Imodium), to help manage symptoms. If you are experiencing diabetic diarrhea, talk to your healthcare provider about the factors that might be contributing and how you might keep symptoms at bay. It is unknown if this drug passes into breast milk. This causes your blood sugar levels to increase. Hiking Macchu Picchu? Sharing needles or pens can result in transmission of hepatitis viruses, HIV, or other blood-borne illnesses. National Institute of Diabetes and Digestive and Kidney Diseases. Its also a good idea to take the medicine with meals instead of on a empty stomach. During the night our nervous system normally ensures that our bowels are quiet so that we can sleep but if the nerves are damaged then this does not happen and night time diarrhea can be the result. Its unclear why this happens. Continue reading >>, Caring for a diabetic pet can be challenging, but there are certain precautions pet owners can take to prevent a diabetic emergency like hypoglycemia. Study Finds Many with Type 1 Diabetes Are Misdiagnosed with Type 2 More than a third of people over the age of 30 who a Tweet An insulin pump is a machine which enables insulin to be delivered either automatically, or in response to instruc Diabetes impairs your bodys ability to produce or use insulin, which regulates blood glucose levels and generates ene Tweet Being prescribed with insulin can be daunting following a diabetes diagnosis. Through medication and lifestyle changes, you may be able to limit your diabetic diarrhea symptoms. T1D occurs when the immune system mistakenly attacks the beta cells in the pancreas. Once your pet has responded to the sugar administration and is sitting up, it can be fed a small amount of its regular food. Well usually have people start with 500 mg at dinner for one week, then add 500 at breakfast the next week, then add a second 500 at dinner the following week and so on. This can lead to high blood sugar levels, or hyperglycemia and a range of complications, including nerve damage, or diabetic neuropathy. Well usually have people start with 500 mg at dinner for one week, then add 500 at breakfast the next week, then add a second 500 at dinner the following week and so on. Renal (kidney) dysfunction - your kidneys may not work well due to a condition called Renal Tubular Acidosis (RTA). The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. do not exercise as much as usual. Diabetes can damage the ENS, increasing the risk for gastrointestinal issues, including diarrhea. Both conditions can be easily treated with medicine. Continue reading >>, Diabetes is a disease in which the body either does not produce or is unable to use the hormone insulin properly. A small bowel tissue biopsy taken during an endoscopic procedure of the upper gut is often used to confirm the diagnosis of celiac disease. Diarrhea related to diabetes is typically a progressive process once it sets in. Are you diabetic or could you be pre diabetic World Diabetes Day 2017, Diabetic emergencies: Warning signs and what to do. You will want to make sure you are getting the right treatment. It was approved for use by the Food and Drug Administration (FDA) in 2000 as the first long-acting human insulin administered once a day with a 24-hour sugar-lowering effect. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). Symptoms of low blood sugar may include headache, nausea, hunger, confusion, drowsiness, weakness, dizziness, blurred vision, fast heartbeat, sweating, tremor, trouble concentrating, confusions, or seizure (convulsions). Of course, never stop a med without your doctors blessing. A word about sorbitol and naturally occurring sugars Many people may Lantus is manufactured by Sanofi-Aventis. Causes, Symptoms, Treatment, Prevention, What You Should Know About the Diabetes-Diarrhea Link. Continue reading >>, Information on: Diabetic Gastroparesis and more Read more about diabetic: esophagus / stomach / bowels The Diabetic Bowels: Issues and Challenges, Constipation/Diarrhea. Take your early symptoms seriously. If too much does get through the body cannot deal with it and it is then that you become ill. Secondly it keeps down the amount of sugar that is produced by the liver. Research has shown that diabetes may lead to problems with your memory. All content is strictly informational and should not be considered medical advice. Metformin is available on prescription as tablets and as a liquid that you drink. Study: Countries That Use More High Fructose Corn Syrup Have More Diabetes, Diabetes management 3: the pathogenesis and management of diabetic foot ulcers, Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management. Its important to note that individuals differ in their sensitivity to the effects of high blood glucose: Some people feel symptoms more quickly or more strongly than others. One of the most significant steps you can take is to keep your blood sugars within your target range. You can learn more about how we ensure our content is accurate and current by reading our. It's not easy when you're a kid with diabetes or food allergies. How Diabetic Neuropathy Is Diagnosed and Treated. Fras Ordoez JS, et al. The possible causes include fewer digestive enzymes being released from the pancreas, overuse of magnesium-containing antacids, or too many bacteria in the upper part of the intestine (where they should not normally be). If nerve damage occurs in the digestive tract, constipation or diarrhea, or both are possible. These complications, along with some diabetes medication, can increase the risk of diarrhea. To get energy, the body starts to burn fat. This can cause bloating and indigestion. Metformin does not cause weight gain (unlike some other diabetes medicines). allergies and food intolerances, such as to dairy and fructose, long-term use of antibiotics, which can affect the makeup of the gut microbiota, medications, such as antacids containing magnesium and some cancer therapies, practicing pelvic floor training, and possibly getting a colostomy, for people with fecal incontinence. DKA is a very serious condition. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol. Continue reading >>, The common diabetes drug Metformin (also known as Glucophage) is notorious for causing diarrhea, especially if started at higher dosages. Discuss a plan to manage blood sugar with your doctor before becoming pregnant. Kidney damage from diabetes (diabetic nephropathy). Researchers believe this is the often the result of a condition known as diabetic neuropathy. Symptoms include dry mouth, increased thirst, increased urination, uneven heartbeats, muscle pain or weakness, leg pain or discomfort, or confusion The total daily insulin requirement varies and the dose is usually between 0.5 to 1 unit/kg/day. Preventing a health crisis in a dog or cat with diabetes involves employing a consistent daily routine involving diet, exercise, insulin therapy, and supplementation. Insulin is the hormone that controls the level of sugar in your blood. Check with your doctor immediately if any of the following side effects occur while taking insulin glargine: More common Blindness blurred vision cough or hoarseness decreased vision diarrhea dizziness fever or chills general feeling of discomfort or illness headache joint pain lower back or side pain loss of appetite muscle aches and pains nausea Insulin needs may be altered during stress, major illness, or changes in exercise, meal patterns, or co-administered drugs. Adjusting Your Diabetes Medication If youre on one of the medication regimens described in this book, the answer is simple: you take the amount and type of medication that youd normally take to cover the basal, or fasting, state and skip any doses that are intended to cover meals. Pharmacologic agents for chronic diarrhea. Pneumonia and urinary tract infections are common illnesses that can lead to diabetic ketoacidosis. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. About 6% of people with type 1 diabetes also have celiac disease. Ask a doctor before making any major dietary changes. Diarrhea can also be a side effect of some diabetes medications. As a result of this some people who already have to inject may find that they no longer have to do this, or at least cut down the amount of times they have to do it. Tell your doctor all prescription and over-the-counter medications and supplements you use. The maximum dose is 2,500 mg per day, and this is often the amount of medicine needed. This type of nerve damage is usually associated with type 1 diabetes and is more common if the diabetes is long standing and has been poorly controlled. It can be difficult to talk about such a private bodily process, but speaking openly with your healthcare provider can help identify the factors that are contributing to your diarrhea and what might be done to alleviate it. Can Intermittent Fasting Decrease Your Type 2 Diabetes Risk? Insulin And Diarrhea - From Fda Reports. What Are the Symptoms of Uncontrolled Diabetes? But by keeping your diabetes in check that means maintaining good blood sugar control and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes. Diabetes and diarrhea There are various things that can cause diarrhea. Medications that cause RTA include Cisplatin and Amphotericin B. Diabetes doctors: Which specialists treat diabetes? If a person has celiac disease or lactose intolerance, dietary changes usually help to keep diarrhea and associated symptoms at bay, such as abdominal bloating. Kelly Burch is a freelance journalist who has covered health topics for more than 10 years. Sometimes it occurs because of overgrowth of bacteria in the intestines. Cure? These include: Large amounts of sugar alcohols, such as sorbitol, that are often used in sugar-free products Some medications, such as metformin, a common medication used to treat diabetes In some cases, such as with illness or the use of sugar alcohols, diarrhea does not . Although mononeuropathy can cause severe pain . 1 Beneficial gut bacteria support gut health and immunity, as well as reduce disease risk. Lantus is meant to be used alongside a proper diet and exercise program recommended by your doctor. Other common side effects of Lantus include pain, redness, swelling, itching, or thickening of the skin at the injection site. DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. Some people may prefer easy-to-take drugs; others want one that won't cause weight gain; still others may desire something that allows them to adjust dosing on a daily basis. That's because your brain needs glucose to function. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual dysfunction. Diabetic Diarrhea Symptoms Watery painless diarrhea Night time diarrhea (nocturnal diarrhea) Episodes of diarrhea along with periods of normal bowel movements or even The pancreas produces insulin, which helps the body use sugar (glucose) from foods. Common causes include viral or bacterial infections and certain medical conditions, such as celiac disease or irritable bowel syndrome (see Diarrhea Causes). Similarly, if you take an ISA on arising and/or at bedtime for the fasting state, and again to cover meals, you skip the doses for those meals that you do not plan to eat. How do we know this is the case? Treat Your Diabetes Well. Eating it can cause your body to attack the lining of the small intestine, leading to diarrhea. They will advise whether you should continue to take your medication or if you need a new prescription. Lantus Warnings You will be taught how to properly inject this medication since that is the only way to use it. Are Microbiome Changes a Cause or Symptom of Type 1 Diabetes? Older adults with diabetes may experience frequent diarrhea more often. If, for example, you ordinarily take detemir or glargine as basal insulin upon arising and at bedtime, and regular or lispro (or aspart or glulisine) insulin before meals, youd continue the basal insulin and skip the preprandial regular or lispro for those meals you wont be eating. Prior to that he was on Caninsulin 7 units twice a day but my veterinarian said it was not effective after doing several glucose curves.We have been seeing the doctor regularly and I have mentioned the diarrhea however he did not seem to be concerned about it.In my opinion the diarrhea is getting more severe with many trips to the litter box.He is eating well and does not appear to be in distress.but I am worried he will become dehydrated . Diabetes can cause a range of complications, such as neuropathy, or nerve damage, and bacterial overgrowth. Clinical recommendation Evidence rating References Initial work-up for gastroparesis should include a complete history and physical examination, along with pertin Symptoms & causes of diarrhea. Continue reading >>, Studies show that 22 percent of people who have diabetes usually experience symptoms of diarrhea (diarrhoea). Even the most diligent pet parent can find himself facing a diabetic emergency with a dog or cat. They are controlled by a complex nervous system. I've had type 1 diabetes for 36 years and been diagnosed as having diabetic diarrhea. It is not safe for one pen to be used for more than one person. Taken as prescribed,. Potassium is one of many electrolytes in your body. Limiting or avoiding artificial sweeteners, such as sorbitol, may help. In EPI, the pancreas does not produce enough digestive enzymes. Last medically reviewed on March 21, 2019, Type 1 and type 2 diabetes both relate to the bodys use of insulin but have different causes and treatments. Sexual dysfunction. This condition can lead to numbness, and sometimes pain and weakness, in the hands, arms, feet, and legs. Low blood sugar (hypoglycemia) The most common side effect experienced with insulin therapy is hypoglycemia. Author disclosure: Nothing to disclose. Most often, diabetic neuropathy is associated with a loss of feeling in the feet or legs. Medications and other approaches can help reduce symptoms and the likelihood of diarrhea from other factors. Murao S. (2010). Gastrointestinal problems, including persistent diarrhea, are fairly common with diabetes. Idiopathic diarrhea is a common complication of diabetes mellitus. Even the severity of symptoms is closely linked to the glycemic control of the individual. They include: You can take steps to prevent diabetic diarrhea, even before you begin experiencing it. Can type 2 diabetes become type 1 diabetes? A practical approach to gastrointestinal complications of diabetes. Also, patients with diabetes, especially teenagers, may need special counseling about insulin dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Explain that in the same way, direct existence and indirect existence are obviously also combined. See additional information. In type 2 diabetes mellitus, your body does not produce enough insulin, or the insulin produced is not used properly, causing a rise in blood sugar. All rights reserved. This might include: If your diarrhea is associated with ENS damage, treatment with serotonin receptor antagonists may help restore more normal function in the digestive tract. If you are taking metformin to treat type 2 diabetes and experience chronic diarrhea, talk to your healthcare provider about whether there are other options available to help control your blood sugar. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems. Learn more about how type 2 diabetes affects your heart. Kalra S, Sharma A, Priya G. Diabetic gastroparesis. As a result, people with T1D produce little or no insulin, which leads to high blood sugar levels. Last medically reviewed on August 18, 2022. Its also a good idea to take the medicine with meals instead of on a empty stomach. Gray A, et al. Sorbitol has proven to be a potent laxative in amounts as small as 10 grams. This is the first-line drug. The most common side effects of Lantus is hypoglycemia, or low blood sugar. Inulin is a type of prebiotic, a compound that encourages the healthy growth of gut bacteria. Continue reading >>, Diabetes occurs when your body is unable to produce or use insulin. However, sorbitol can contribute to diarrhea because its also a laxative. Sometimes you will still get diabetic diarrhea even though the blood sugar levels are well regulated. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, GLP-1 receptor agonists and DPP-4 inhibitors, https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/autonomic-neuropathy, http://www.diabetes.org/food-and-fitness/food/planning-meals/gluten-free-diets/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148449/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014788/, https://www.hindawi.com/journals/jdr/2018/3827301/, http://care.diabetesjournals.org/content/33/3/e38, A safer blood thinner? 2023 Healthline Media UK Ltd, Brighton, UK. Chronic diarrhea in adults: evaluation and differential diagnosis. Insulin allows blood sugar (glucose) into your cells so your body can use it as energy. If you have neuropathy in the sphincter muscles that control the bowel, you might experience incontinence in addition to diarrhea. Inulin is also a type of fermentable fiber, meaning bacteria metabolize it in the large intestine. Even people who have been put on the maximum dosage too quickly can often adjust if they stop for a week or so and then restart, building the dosage up slowly. Diabetes: Can gene therapy normalize blood glucose levels? However, most of the signs and symptoms of high blood glucose dont appear until the blood glucose level is higher than 250 mg/dl. The dose of your sulfonylurea medicine or insulin may need to be lowered while you use Victoza. low blood sugar levels *. have diarrhea, a fever, or an infection. Continue reading >>, Precautions Drug information provided by: Micromedex Never share insulin pens or cartridges with others under any circumstances. Damage to the nerves that control movement in the bowel is thought to be a basic cause. Diabetes can cause constipation either directly or indirectly. Frequent veterinary visits are the norm for dogs and cats with diabetes, as are the costs associated with checkups, tests, medical procedures, and insulin therapy. Is Metformin an Effective Treatment for Type 2 Diabetes? What causes people with diabetes to get diarrhea? To manage diarrhea, your doctor may recommend: Depending on their assessment, your doctor may refer you to a gut specialist called a gastroenterologist for further investigation. Exocrine pancreatic insufficiency (EPI) can also occur in people with diabetes. Can I Drink Alcohol If I Have Type 2 Diabetes? We avoid using tertiary references. Diarrhea can happen to anyone, regardless of whether they have diabetes or not. If these nerves have been damaged by high blood sugar levels, food and waste products may move through the intestines too slowly, causing constipation or too quickly, causing diarrhea. However, it only lasts for 2 to 3 days and can be treated using over-the-counter drugs. Controlling blood glucose levels is important for managing most gastrointestinal complications. Healthline Media does not provide medical advice, diagnosis, or treatment. 2021 Jan;22(1):55-68. doi:10.1080/14656566.2020.1812578. This is one of This generally occurs in the hands or feet. How Processed Meat and Refined Carbs Can Increase Your Risk of Type 2 Diabetes, People With Type 2 Diabetes May Live Longer by Giving Up Sugary Drinks. Diabetic enteropathy is a type of nerve damage that affects the digestive system. This medication may be prescribed for other uses. T2D occurs when the pancreas fails to produce enough insulin or when the body becomes resistant to insulin. Metformin lowers your blood sugar levels by improving the way your body handles insulin. Your pancreas releases insulin when you eat. You will want to make sure you are getting the right treatment. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. Damage to the nerves that control movement in the bowel is thought to be a basic cause. The first symptoms to appear are usually: frequent urination. Talk with a doctor if you have diarrhea with diabetes. Can diet help improve depression symptoms? If you have diabetes, discuss any problems that you are having with either constipation or diarrhea with your doctor. Kelly Burch is has written about health topics for more than a decade. Diarrhea: Introduction, Small bowel Bacterial Overgrowth / Treatments for diarrhea / General Bowel Tips Diarrhea in diabetes, Introduction and more: The passage of loose and frequent stools with a sense of urgency is not uncommon with diabetics. Metformin may also be called by the brand names Bolamyn, Diagemet, Glucient, Glucophage, and Metabet. But if youre not eating, it makes sense to ask what dose of insulin or ISA you should take. Users should test their blood sugar two to five times per week. Some practices prefer even longer steps between increases, several weeks or a month, to allow the body to get used to the medicine. This deficiency, in turn, interferes with digestion. These side effects usually go away after a few days or weeks. About 20% of people with diabetes experience diarrhea. In May 2020, the Food and Drug Administration (FDA) recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. Stroke warning signs may include: Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body Feeling confused Difficulty walking and talking and lacking coordination Developing a severe headache for no apparent reason Nerve Damage People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. Signs of other potential impending diabetic emergencies include ketones in the urine; straining to urinate or bloody urine; vomiting or diarrhea; or a complete loss of appetite or reduced appetite for several days. When there is a breakdown or destruction of cells, the electrolyte potassium moves from inside of the cell to outside of the cell wall. Metformin is a drug that is used to treat diabetes. Keeping blood sugar stable will reduce your risk for neuropathy, including the autonomic neuropathy that can contribute to diabetic diarrhea. If not managed and controlled, diabetes can cause a variety of complications. How Low Can You Go? The symptoms of IBS can include two specific details: Ongoing pain in your abdomen Frequent changes in your bowel movements (diarrhea, constipation, or both) Discomfort after eating (but unable to specify a consistent food item as a source of pain) Bloating and gas Difficulty sleeping due to overall discomfort Testing for IBS is difficult. The peristaltic contractions are paced by neoelectrical events called pacesetter potentials or slow waves. Be prepared for an emergency as you would normally. Diabetes occurs when your body cant produce or use the hormone insulin effectively. The main types of diabetes are classified as type 1 and type 2. Thats about six times higher than the rate in the general population. Continue reading >>, The number and variety of diabetes medications can be bewildering, but, on the plus side, that means choice. People with diabetes can get diarrhea just like anyone else. However, diabetic neuropathy can also cause problems in every organ system, including the digestive tract. If you have celiac disease your body cannot tolerate gluten. Diabetic gastroparesis: principles and current trends in management, Chronic diarrhea in adults: evaluation and differential diagnosis, Pharmacologic agents for chronic diarrhea, State-of-the-art pharmacotherapy for diabetic neuropathy, Black and tarry stools, or diarrhea that contains blood or, A greater risk of cardiovascular disease (CVD), including high blood pressure (hypertension). Such universality is defined what can lower my blood sugar and set as totality. In the studies, diarrhea was reported only by adults. This is because the likelihood of diarrhea increases for people with a long history of diabetes. Over time, persistently high blood sugar levels can lead to damage that results in a range of symptoms, including diarrhea in some cases. Bharucha AE, et al. Neuropathy refers to numbness or pain resulting from nerve damage. It is very important to follow carefully any instructions from your health care team about: AlcoholDrinking alcohol may cause severe low blood sugar. A problem with insulin therapy. Causes of diarrhea in diabetics are thought to be related to: Celiac disease (wheat or gluten intolerance) Small bowel bacterial overgrowth Ano-rectal disorders Inadequate breakdown of sugars (fructose, lactose and sorbitol) in the small intestine Constipation can be a cause of diarrhea: more liquid stool may escape around a hard stool impaction. 2018;9(1):1-42. doi:10.1007%2Fs13300-018-0454-9, Burgers K, Lindberg B, Bevis ZJ. Is Sugar-Free Candy the Best Choice If You Have Diabetes? DIABETES AND DIARRHEA In a person with diabetes, the body has difficulty regulating blood sugar levels due to problems with insulin. The most common side effects are feeling sick, vomiting, diarrhoea, stomach ache and going off your food. Diabetes & Constipation: Can Diabetes Cause Constipation? The purple Can Diabetes Medication Cause Diarrhea flowers of the paulownia tree fell weakly on what meds are best for type 2 diabetes injectable insulin diabetes medications the street of the camphor tree diabetic medication cagenta street, and the spring gradually became deeper the wind gradually became hot, and some people began to predict . Victoza may cause serious side effects, including: Low blood sugar (hypoglycemia). Diabetes in America, 3rd edition. Ask your doctor what your critical blood sugar level is. By Dr. Becker Caring for a diabetic pet can be quite complex and time consuming. Diabetes: Study proposes five types, not two, replace any lost fluids by drinking plenty of water, receive fluids in the hospital if symptoms are severe, use an oral rehydration solution (ORS) to replenish salts and other substances that the body needs, gassy foods, such as broccoli, beans, and prunes, sugar alcohols, used to replace sugar in some products, any medication that may have altered the stool, the frequency and consistency of bowel movements, occur intermittently rather than all the time. Quick Stomach Anatomy Lesson The stomach is a neuromusclar organ that receives the food we ingest, mixes the food with acid and pepsin, and empties the nutriment suspension into the small intestine for absorption. The doctor may carry out tests to find out if the diarrhea is due to diabetes or another condition, such as celiac disease or a lactose intolerance. . The most important factor is to manage blood sugar levels. Potassium is excreted (or "flushed out" of your system) by your kidneys. The body and antrum mix and empty the food via recurrent gastric peristalic waves. type 1 (T1D) and type 2 diabetes (T2D). We'll discuss the details. They can diabetes medications cause t remember how it happened in ada standard of medical care in diabetes 2023 the first place, nor can they figure out where it happened. This, too, can contribute to diarrhea symptoms. In fact, this relationship is more common than you or your doctor may realize. Researchers are unsure whether this is related to issues in the small bowel or the colon. Nutritional recommendations for individuals with diabetes. You can learn more about how we ensure our content is accurate and current by reading our. Ask your doctor or pharmacist for more information. Drinking plenty of fluids, particularly water, can prevent dehydration from diarrhea. Many other medicines can increase or decrease the effects of insulin lispro on lowering blood sugar. These hormones work against the effects of insulin and sometimes cause diabetic ketoacidosis. They can make sure doing so wont interfere with other treatments or worsen other symptoms.

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