Q. I am a 78-year-old man who has had Type 1 diabetes for 55 years. As a consequence of my diabetes, the nerves that should move food and waste through my gastrointestinal tract no longer work, and I have to take a stimulant to keep things moving. What can I do to better deal with this problem?
A. It sounds like you’re describing gastroparesis, a form of autonomic neuropathy often associated with diabetes. The autonomic nervous system is in charge of body functions we don’t consciously think about, including heart rate, sweating, and digestion. When autonomic nerves are damaged, the functions normally regulated by those nerves are affected. The first step in managing diabetes-related gastroparesis is keeping blood glucose levels stable and in a safe range.
Another thing that can help is to eat foods that are digested quickly. For instance, non-whole–grain breads, cereals, and crackers; fruit with the peels removed; well-cooked vegetables; and meat that has minimal fat. Because the hallmark of gastroparesis is slowed movement of food and waste through the GI tract, whole grains, fruits with peels, raw vegetables, and fatty foods, all of which take longer to digest, can create more problems. Another idea is to chew your food very well, which helps to start breaking the food down before it gets to your stomach.
Other ideas for managing gastroparesis include eating small, frequent meals throughout the day; choosing liquid foods and low-fiber foods; and avoiding high-fiber foods such as berries, Brussels sprouts, whole grains, and legumes. Carbonated beverages, alcohol, and smoking can worsen gastroparesis, so avoiding these items is helpful.
It is important to work with a health-care professional to make sure you are getting enough fluid in your diet, as well as all the nutrients your body needs. A health-care professional can also help make sure your insulin doses match the amount of food you’re eating and are timed properly. If food is moving through your digestive tract more slowly, you may experience low blood glucose soon after eating and higher blood glucose later on. Changing the timing of your premeal insulin doses can help to keep your blood glucose level more stable.
Current recommendations for managing gastroparesis also include drugs for nausea and vomiting (if that is a problem for you) and gastric electrical stimulation (in which a small device is implanted in the abdomen to send electrical pulses to the nerves in the stomach). Unfortunately these treatments are not always effective, but they may relieve symptoms. If you aren’t getting enough nutrients through food, it may be necessary for you to receive supplemental nutrition through an IV or a tube inserted in your intestines.