G is for Gastroparesis

How is gastroparesis treated if a person has diabetes?

An elevated blood glucose level directly interferes with normal stomach emptying, so good blood glucose control in people with diabetes is important. However, gastroparesis can make blood glucose control difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a person’s blood glucose levels to be erratic and difficult to control.
The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the person’s insulin regimen.
To better control blood glucose, people with diabetes and gastroparesis may need to

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

A health care provider will give specific instructions for taking insulin based on the individual’s needs and the severity of gastroparesis.
In some cases, the dietitian may suggest eating several liquid or puréed meals a day until gastroparesis symptoms improve and blood glucose levels are more stable.

What are the problems of gastroparesis?

The problems of gastroparesis can include

• severe dehydration due to persistent vomiting
• gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagus
• bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form
• difficulty managing blood glucose levels in people with diabetes
• malnutrition due to poor absorption of nutrients or a low calorie intake
• decreased quality of life, including work absences due to severe symptoms
  

Points to Remember

• Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine.
• Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.
• Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests.
• Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve.
• The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite.
• Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests.
• Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed.
• Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition.
• For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen. I have this, it can be a terrible thing to deal with. Totally messes up your digestive system. I have had to be hospitalized repeatedly, due to this problem.