### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am experiencing diarrhea, vomiting and heartburn when eating vegetables, onions.... Do not have much of an appetite and I am a diabetic so I am experiencing great fluctuation in blood sugar. What could be causing me to have these symptoms? Doctor prescribed Pantotrazole Sodium ER 40mg, 1 tablet per day, for acid reflux.

### output:

Welcome! Let's start with making certain the medication is taken properly. Pantoprazole is a proton pump inhibitor and needs to be taken 30-60 minutes before any food is taken. It may decrease absorption of iron, B12, and calcium. Long term use may lead to osteoporosis, so calcium supplementation may be advised. Avoid ginkgo or St. Johns Wort. It may also increase glucose. So, I reviewed these things because if you violate any of the above it may cause a greater fluctuation than Pantoprazole will cause by itself. Source: 2015 Chat Doctor.  Are the vegetables fresh only or certain vegetables only or anything cooked with onions that make you ill? I am wondering about a developing food intolerance or not using a designated vegetable scrubber to get the increasing levels of foodborne bacteria present on our fresh foods. The gold standard for narrowing down this problem is to keep one of those tedious food diaries to tease out the problem. Date, time,food, symptoms for 7 entire days as sometimes it takes up to 3 days for an infection to kick in. Food intolerances are individual, but have seen them change with time. Avoid all sugar substitutes for right now. When you have additional information, please write me again, and we will see if I can suggest some things to stabilize your blood sugars and stop your symptoms. Thank you for your time. Sometimes solving a medical mystery requires more information. Good luck. Kathy Shatter, MS, RDN