As always, a big thank you to those of you who shared your gastroparesis stories this past week (see "Gastroparesis: That Gut Feeling [Part 1]"). I can’t imagine that this is an easy complication of diabetes to deal with, yet I’m also heartened to hear of some success stories. Diabetes and its complications are managed and treated in varying ways, and what works for one person doesn’t always work for another. Trial and error, plus a lot of patience, is usually what works best.
Treatment of Gastroparesis
One of the first steps in dealing with any complication of diabetes is to focus on blood glucose control. I know that this is pretty obvious, but it rings true especially for gastroparesis. Why? Because if you have this condition and your blood glucose levels are consistently running above your target range, your symptoms are likely to be much worse.
High blood glucose levels can slow down stomach emptying even more, leading to an exacerbation of symptoms. So, as hard as this can be, work with your team to regulate your blood glucose as best as you can.
Diet and Nutrition
The second step in managing gastroparesis is to focus on your diet. You may need to experiment a little and tweak things here and there to find what works best for you. Working with a dietitian can be a big help.
- Smaller, more frequent meals: When you think about this, it makes sense. Rather than eating two or three large meals every day, which puts a strain on your stomach that, if you recall, is struggling to empty all that food, try eating smaller meals, but more often. For some people, this may mean eating four to six times a day. Eating more often may take some getting used to, especially if you never eat between meals. However, by doing so, you’ll likely feel better and you’ll be able to enhance your nutrition. If appetite is an issue, try to eat your most nutritious foods earlier in the day.
- Less fat and fiber: Fat and fiber like to hang around for a while in your stomach, so go easy with fried foods and high-fiber foods, such as bran cereal or broccoli, for example. It’s also important to avoid forming bezoars (undigested food). However, that’s not to say that you can’t eat any fat or fiber. Again, you’ll need to figure out how much you can tolerate without worsening symptoms. Also, if you’ve lost weight as a result of gastroparesis, some fat is good, since it’s so dense in calories.
- Liquids and pureed foods: Liquids leave the stomach a lot faster than solid foods, so, depending on the severity of your symptoms and at what time of the day they occur, you may do better with a more liquid meal. For example, if you feel worse in the morning, an instant breakfast drink, a milkshake, or a nutritional supplement (such as Glucerna or Ensure) may be better tolerated than toast and eggs. All foods can be pureed in a blender or food processor, and while they may not look all that appetizing, the nutrition is still there. Some people can really only tolerate liquefied meals, so soups and pureed foods become the mainstays of the diet. Others may be able to eat solid foods during the first part of the day, but then transition over to more liquids to avoid increased fullness and bloating that may occur later in the day.
More severe cases of gastroparesis can be treated with tube feedings, whereby a tube is inserted into the stomach or small intestine and a nutritional formula is given via the tube. Tube feedings can be temporary and used during times when gastroparesis “flares up.” In more extreme situations, intravenous feedings can be provided via a catheter inserted into a vein. However, the use of intravenous feedings in people with gastroparesis is pretty uncommon and should be used only if a person’s gastrointestinal tract is not functioning.
Next week: Drugs for treating gastroparesis, and more!