Regional Gastrointestinal Consultants

Gastroparesis and Diabetes

Gastroparesis and Diabetes

Gastroparesis & Diabetes

Overview

Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. It often occurs in people with type 1 diabetes or type 2 diabetes.

Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.

Major Causes of Gastroparesis are:

  • diabetes
  • postviral syndromes
  • anorexia nervosa
  • surgery on the stomach or vagus nerve
  • medications, particularly anticholinergics and narcotics (drugs that slow contractions in the intestine)
  • gastroesophageal reflux disease (rarely)
  • smooth muscle disorders such as amyloidosis and scleroderma
  • nervous system diseases, including abdominal migraine and Parkinson’s disease
  • metabolic disorders, including hypothyroidism

Symptoms

Signs and symptoms of gastroparesis are:

  • heartburn
  • nausea
  • vomiting of undigested food
  • an early feeling of fullness when eating
  • weight loss
  • abdominal bloating
  • erratic blood glucose levels
  • lack of appetite
  • gastroesophageal reflux
  • spasms of the stomach wall
  • These symptoms may be mild or severe, depending on the person.

Also, if food lingers too long in the stomach, it can cause problems like bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Gastroparesis can make diabetes worse by adding to the difficulty of controlling blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person’s blood glucose levels can be erratic and difficult to control.

Treatment

The primary treatment goal for gastroparesis related to diabetes is to regain control of blood glucose levels. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding.

It is important to note that in most cases treatment does not cure gastroparesis – it is usually a chronic condition. Treatment helps you manage the condition so that you can be as healthy and comfortable as possible.

Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To control blood glucose, you may need to:

  • take insulin more often.
  • take your insulin after you eat instead of before.
  • check your blood glucose levels frequently after you eat and administer insulin whenever necessary.

Your doctor will give you specific instructions based on your particular needs.

Medication

Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.

  • Metoclopramide (Reglan). This drug stimulates stomach muscle contractions to help empty food. It also helps reduce nausea and vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug are fatigue, sleepiness, and sometimes depression, anxiety, and problems with physical movement.
  • Erythromycin. This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects are nausea, vomiting, and abdominal cramps.
  • Domperidone. The Food and Drug Administration is reviewing domperidone, which has been used elsewhere in the world to treat gastroparesis. It is a promotility agent like metoclopramide. Domperidone also helps with nausea.
  • Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, an antiemetic can help with nausea and vomiting. Antibiotics will clear up a bacterial infection. If you have a bezoar, the doctor may use an endoscope to inject medication that will dissolve it.

Meal and Food Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis is corrected. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion–a problem you do not need if you have gastroparesis–and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Also, it is worth noting that new treatments are being analyzed as well.

IMPORTANT HEALTH NOTE

We recommend that people experiencing gastrointestinal symptoms do not attempt self-treatment. With many medications being available over the counter, and numerous do-it-yourself online unqualified remedy recommendation, it is natural to consider treating yourself but we highly recommend against this.

If you are experiencing gastrointestinal symptoms you may have a more significant issue than you would expect from the sometimes muted or infrequent symptom you may be experiencing. It is important to keep in mind that is you are having gastrointestinal symptoms or concerns it is best see a doctor to have those symptoms diagnosed and any conditions treated. Also, it is worth noting, that if health conditions do exist, the earlier they are diagnosed and treated, the greater the probability will be to successfully eliminate or manage a present condition, in fact successful outcomes will increase significantly with early detection.

If you have gastrointestinal concerns or are experiencing any gastrointestinal symptoms, please contact us promptly to schedule a consultation with a physician.


DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way, does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a best in class physician regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today at (215) 321-4700 to schedule a consultation.