Managing Gastroparesis

Poorly controlled diabetes can damage your stomach. It can interfere with eating and with digestion. Diabetic stomach worsens blood glucose control and causes a range of symptoms. This complication is called “gastroparesis” (pronounced gas-tro-pa-REESE-es).

What causes this complication? How can we prevent it and manage it?
Gastroparesis means “weak stomach.” The nerve that tells the stomach to contract and push food along has been damaged, so the stomach muscles don’t work properly. Food stays in the stomach instead of being passed along to the intestine.

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This delayed emptying causes painful, unpleasant symptoms and leads to further complications. Studies show gastroparesis is related to a heightened risk of death, more complications, increased hospitalizations, and increased emergency department and doctor visits.

Gastroparesis symptoms include heartburn, nausea, vomiting of undigested food, an early feeling of fullness after meals, weight loss, lack of appetite, gastric reflux, and stomach pain.

Because food can stay in the stomach and start to ferment, patients can get terrible bad breath. Because of all these symptoms, gastroparesis can make it difficult or impossible to hold a job.

Sometimes undigested food forms solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach.

Because food intake may be limited, and food may be poorly absorbed, people with gastroparesis are at risk for malnutrition and dehydration. They usually need to drastically change the way they eat — as if diabetes didn’t demand enough changes already — and take supplements.

Although diabetes is the number one cause of gastroparesis, many cases have no known cause. A study published in 2012 in the journal Clinical Gastroenterology and Hepatology found that up to 12% of people with diabetes have symptoms of gastroparesis. Many fewer are diagnosed with the condition, because gastroparesis can have symptoms similar to other conditions and diagnosis requires extensive medical testing. Other studies report higher numbers.

In diabetic gastroparesis, scientists think high glucose levels damage the vagus nerve, which stimulates the stomach and other organs. For some unknown reason, women are more likely than men to get gastroparesis. It is much more common in Type 1 diabetes than in Type 2.

Effect on glucose control
Gastroparesis makes it more difficult to manage blood glucose. When food has been delayed in the stomach and then finally enters the small intestine and is absorbed, blood glucose levels rise. It’s very hard to match your insulin to your food intake when you don’t know how long the food will take to absorb.

According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), if you take insulin, you might need to:

• take insulin more often or change the type of insulin you take
• take insulin after meals, instead of before
• check blood glucose levels frequently after eating and administer insulin when necessary

Medical treatments
There are treatments for gastroparesis, but no cure. Some people do get better, but it’s more common to have it for life. Sometimes it comes and goes.

Medications for the condition include metoclopramide (brand name Reglan) and erythromycin. The first can have a possibly irreversible neurologic side effect, so you will need to research and to ask your doctor about it. Erythromycin is an antibiotic and has few side effects.

Some doctors have tried injecting botulism toxin (Botox) into the pyloric valve between the stomach and the small intestine. This keeps the valve open so food can exit the stomach more easily. The benefits of a Botox injection seem to last up to about six months, according to GPACT (Gastroparesis Patients Association for Cures and Treatments).

Gastric electrical stimulation is like a pacemaker for the stomach. It seems to reduce symptoms such as nausea and vomiting, but is “not a cure,” according to one manufacturer, Medtronic. You can see Medtronic’s information for consumers here.

If the stomach is too weak, it can be kept out of the system entirely by inserting a feeding tube directly into the small intestine. Then the person needs to live on special tube-feeding liquid until the stomach recovers, if it ever does. This is called a jejunostomy.

Self-managing gastroparesis
Self-care is mostly about eating in ways your stomach can handle, and lowering glucose levels. To help food move along, WebMD, the American Diabetes Association, and the NIDDK recommend:

• Eat less food at one time. For example, eating six or more small meals a day instead of three larger meals.

• Eat slowly, chew thoroughly.

• Pureed foods and liquid foods like Ensure will be much easier to get through the stomach. You can see some Diabetes Self-Management liquid food recipes here.

• In consultation with your health-care provider, take vitamins and minerals.

• Sit upright after eating, and/or take a walk after meals.

• Some people appear to do better if they eat less fat and less fiber, because fat and fiber slow digestion. This advice is against normal diabetes advice, but the slow stomach can change the rules of good eating

You can see a thorough description of how to eat in this University of Virginia page.

Another good resource on our site is this article by Kathryn Feigenbaum, RN, MSN, CDE.

There are also self-help books like Living (Well!) with Gastroparesis, which gets raves from customers that can be seen here.

I hope this helps. Gastroparesis is a nasty condition, but it can be managed and hopefully prevented with good glucose control and some of these self-care measures.

Here’s the truth: There’s no such thing as a “bad diabetic.” Bookmark DiabetesSelfManagement.com and tune in tomorrow to read more.

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  • josie53

    I noticed a mention of Reglan which has horrific side effects. My daughter who is not diabetic was diagnosed with a slow digestion which is painful left untreated. Reflag was too fraught with side effects for her to take it. An gastroenterologist suggested Domperidone which does not cross the blood brain barrier. The FDA removed it from the market saying it hadn’t been tested with pregnant women. It is legal in other countries including Canada. The Mayo Clinic makes it possible for my daughter to obtain it and it has worked amazingly well. She no longer suffers from ‘slow digestion’. So I’d suggest talking with a gastroenterologist about this possibility

  • Joan G

    Great article, David, thank you. More info to share in my DSME classes. Gastroparesis is often neglected in education.