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Diabetes Care 44 , 765773 (2021)

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Patients with the following conditions should exercise particular caution: Pre-existing inflammatory bowel disease History of ulcerative colitis, Crohn's disease, or microscopic colitis Cardiovascular disease Atherosclerotic disease or conditions affecting blood flow may increase ischemic colitis risk Advanced age Older adults may have reduced intestinal blood flow and increased susceptibility to ischemic events History of diverticular disease Pre-existing colonic abnormalities may complicate symptom interpretation Dehydration or hypotension Reduced fluid volume may compromise intestinal perfusion Severe constipation May increase risk of complications with altered GI motility Concurrent medications NSAIDs, anticoagulants, or other drugs affecting gastrointestinal mucosa or blood flow Contact your healthcare provider immediately if you experience: Blood in stool or black, tarry stools indicating gastrointestinal bleeding Severe, persistent abdominal pain unrelieved by usual measures High fever (temperature above 101F/38.3C) with gastrointestinal symptoms Signs of dehydrationdecreased urination, dizziness, extreme thirst, or confusion Persistent vomiting preventing adequate fluid or medication intake Sudden worsening of symptoms or new symptoms after stable treatment period Seek emergency care (call 911 or go to the emergency department) for: Severe, uncontrolled bleeding from the rectum Severe abdominal pain with fever and abdominal rigidity/tenderness Fainting, dizziness, or rapid heart rate with gastrointestinal symptoms Signs of shock (confusion, cold/clammy skin, very low blood pressure) Routine follow-up appointments should include discussion of any gastrointestinal symptoms, even if mild

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