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Red flag symptoms requiring urgent assessment include: Severe abdominal pain or distension that is progressive or unrelieved Nausea and vomiting, particularly if unable to tolerate oral intake Inability to pass gas or persistent vomiting (possible signs of obstruction) Rectal bleeding or black, tarry stools suggesting gastrointestinal bleeding Unintentional weight loss beyond expected therapeutic effects Fever accompanying constipation, which may indicate infection or inflammation Signs of dehydration (extreme thirst, dry mouth, dizziness, dark urine) Patients with pre-existing gastrointestinal conditionsincluding inflammatory bowel disease, previous bowel obstruction, or diverticular diseaseshould have lower thresholds for seeking medical advice

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Secondary DM (E08): Conditions that destroy pancreatic tissue (chronic pancreatitis, cystic fibrosis, hemochromatosis, pancreatic cancer) or cause hormonal insulin antagonism (Cushing syndrome cortisol excess

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