Diabetes is associated with an increased risk of certain complications, especially if blood sugars aren’t well-managed over a long period.
One of these potential complications is diabetic gastroparesis, which affects the functioning of the stomach muscles.
Gastroparesis can have other causes, but its most common cause is diabetes.
Keeping blood sugar levels well-controlled is the best way to prevent gastroparesis.
There are many treatment options for those who have diabetic gastroparesis to reduce symptoms and improve quality of life.
There are nine common symptoms of gastroparesis, the majority of which are gastrointestinal.
What is diabetic gastroparesis?
Diabetic gastroparesis is a complication affecting people with diabetes mellitus or diabetes. Chronic high blood sugar from diabetes can cause nerve damage, including the nerves responsible for gastric emptying. Nerves responsible for unconscious movements such as digestion are part of the autonomic nervous system.
When nerves in this system are damaged, it’s called autonomic neuropathy. Autonomic neuropathy is a potential complication in diabetic patients, especially those diagnosed in their younger years.
The vagus nerve is responsible for signaling the digestive tract’s smooth muscle to contract, allowing food to propel from the esophagus to the stomach, then through the small intestine, and finally through the large intestines until it’s eliminated.
With diabetic gastroparesis, the vagus nerve is damaged, interfering with gastric emptying. This means that food stays in the digestive tract longer than it should, which can cause several uncomfortable symptoms.
Gastroparesis usually has a known cause, such as in the case of diabetic gastroparesis. However, when the cause of gastroparesis is unknown, it’s referred to as idiopathic gastroparesis.
Gastroparesis is also considered a gastric dysrhythmia, meaning the rhythm of the gastric contractions is abnormal.
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Why is gastroparesis a problem for type 2 diabetics?
The majority of people with diabetic gastroparesis have type 1 diabetes; however, people with type 2 diabetes can also develop diabetic gastroparesis. Approximately between 10 and 30% of people with type 2 diabetes develop diabetic gastroparesis.
Most people with gastroparesis have had diabetes for at least ten years and are more likely to have other diabetic complications too.
Gastroparesis can not only cause adverse digestive side effects, but it can interfere with blood glucose control as well. A common problem for people with gastroparesis is its interference with insulin and other blood sugar-lowering medications.
For instance, let’s say you have gastroparesis and take rapid-acting insulin at meals. You inject ten units before lunch and then eat your meal. However, the food will stay in your stomach longer than usual, which means your blood sugar levels won’t rise as quickly. The insulin you took may start working to lower your blood sugar before your meal digests, and the glucose absorbs into the bloodstream, which can result in low blood sugar.
On the other hand, diabetic gastroparesis can also cause high blood sugar for the same reason. Once the food finally reaches the small intestine, where it’s available to convert into glucose, the blood sugar-lowering effects of insulin may have already worn off, leading to postprandial high blood sugar.
Overall, the variations in the speed of digestion can cause blood sugar levels to be erratic, even in place of medication use.
Symptoms of diabetic gastroparesis
Most of the symptoms of gastroparesis are gastrointestinal. Not everyone with gastroparesis will experience the same symptoms, though.
Some of the most common symptoms of gastroparesis include:
1) Abdominal pain
When food stays in the stomach longer than usual, it can result in abdominal pain. Food that takes a long time to empty from the stomach even in the absence of gastroparesis tends to worsen abdominal discomforts, such as high-fat and high-fiber foods.
2) Nausea
Food isn’t meant to remain in the stomach for long periods. When this happens, it can trigger nausea in the patient with gastroparesis. Nausea is the feeling of needing to vomit, especially when there is a feeling of fullness in the stomach.
Nausea can worsen malnutrition in people with gastroparesis since they can feel full without eating enough calories, especially if they feel nauseous.
3) Vomiting
Food remaining in the stomach for long periods can cause nausea and then vomiting. Undigested food in the stomach can also increase the pressure in the abdomen, which causes it to come back up the esophagus.
4) Postprandial fullness
One of the most distinguishable symptoms of gastroparesis is a feeling of fullness, even after only eating a small amount of food.
People with gastroparesis may only take a few bites of food before feeling full. It’s ideal to eat several small meals throughout the day versus eating larger meals to minimize this early satiety.
5) Loss of appetite
The stomach emptying stimulates the feeling of hunger. With gastroparesis, food stays in the stomach longer due to delayed emptying, which can cause a loss of appetite from the lack of natural hunger cues.
The multiple uncomfortable symptoms of gastroparesis can also worsen a poor appetite, especially with severe symptoms.
6) Bloating
When food stays in the stomach for an extended period, it can trigger bloating, which is when the stomach becomes distended with air.
Bloating can arise from excess gas production as well as disturbances in gastric motility. Gas builds up due to bacteria in the digestive system breaking down (fermenting) food in the large intestine.
If food is moving more slowly in the digestive tract, bacteria in the colon have a longer time to ferment these foods, releasing more gas in the process.
7) Acid reflux
Gastroesophageal reflux, or GERD, is the medical term for heartburn. After swallowing, the esophagus propels food to the stomach.
Gastroparesis can increase the pressure in the abdomen, causing some of the stomach acid to travel back up the esophagus, resulting in an uncomfortable burning sensation from the stomach acid burning the tissue of the esophagus.
RELATED: Acid Reflux Diet: Foods To Eat And Foods To Avoid.
8) Weight loss
People with diabetic gastroparesis are more likely to develop malnutrition and weight loss due to the multiple uncomfortable symptoms of gastroparesis.
Nausea, early satiety, and bloating can all lead to a lack of appetite and reduced intake, which increases the risk of malnutrition and unintentional weight loss.
9) Blood sugar fluctuations
The changes in the rate of digestion can cause both high and low blood sugar levels. Food can’t break down into blood glucose until it’s emptied from the stomach into the small intestine, where it’s then broken down and absorbed into the bloodstream.
Impaired gastric motility and delayed gastric emptying can cause erratic blood sugar levels, making blood sugar management more difficult.
Prevention and Treatment
The primary way to prevent diabetic gastroparesis is to keep your diabetes well-controlled. Uncontrolled blood sugars over a long period are more likely to cause nerve damage and gastroparesis.
Keeping blood sugar levels in your target range will reduce the risk of diabetes complications overall, including gastroparesis.
There are several treatment options for gastroparesis, ranging from diet changes to surgical interventions.
Some of the recommended dietary modifications include:
- Avoiding high-fat and high-fiber foods
- Eating small meals more often
- Blending foods and/or chewing food very thoroughly
- Increasing high-fat liquids to meet fat requirements
- Avoiding carbonated beverages
- Staying hydrated
- Staying upright after eating
- Eating more solid foods in the morning and liquids later in the day
Tricyclic antidepressants
Tricyclic antidepressants such as nortriptyline can improve gastric emptying and reduce symptoms such as nausea, vomiting, and abdominal pain.
Another type of antidepressant called mirtazapine may also reduce nausea and vomiting but may not impact gastric emptying.
Metoclopramide
Metoclopramide, otherwise known as Reglan, is a medication that can treat gastroparesis. It works by increasing the smooth muscle contractions of the digestive tract, helping to minimize symptoms.
There is a small risk of tardive dyskinesia (a potentially irreversible disorder resulting in involuntary movements) when using metoclopramide.
But it depends on the dose and duration of taking it. People exhibiting signs of tardive dyskinesia should stop using metoclopramide immediately.
Parenteral nutrition
People with severe gastroparesis may need parenteral nutrition to deliver adequate nutrition and allow the digestive tract to rest.
Parenteral nutrition is the administration of both macro and micronutrients intravenously, and it can even be set up to deliver at home through home health or similar situations.
Botulinum toxin
Injection of botulinum toxin, otherwise known as Botox, into the smooth muscle of the stomach can help improve stomach emptying from the pylorus (the opening from the stomach to the small intestine).
Botulinum toxin is an option to treat refractory gastroparesis, which is a gastroparesis that hasn’t been controlled with diet or less invasive treatment methods.
Gastric electrical stimulator
A gastric electrical stimulator device helps stimulate the stomach walls to help it empty. This device is placed under the skin near the abdominal area and delivers controlled electrical pulses to the stomach, helping to reduce symptoms. Doctors may also reserve this treatment for cases of severe gastroparesis.
Conclusion
Diabetic gastroparesis is a complication of uncontrolled diabetes where the vagus nerve of the stomach is damaged. The vagus nerve helps control gastric emptying and promotes gastric motility.
Gastroparesis delays stomach emptying, resulting in symptoms such as abdominal pain, nausea, vomiting, early satiety, loss of appetite, bloating, acid reflux, weight loss, and erratic blood sugars.
Good blood sugar control is the best way to prevent diabetic gastroparesis. However, there are several treatment options such as diet changes, medication use, parenteral nutrition, Botox injections, and gastric electrical stimulators, aiming to reduce symptoms and improve quality of life.
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