The holiday season will hit in just a few weeks, and we're prepping our pumps to handle the onslaught of holiday cookies and big family dinners involving waaaay more food than necessary. But diabetes isn't the only thing that can make big meals a challenge. For some people, a condition called gastroparesis can cause more trouble than just worrying about post-prandial spikes from overdoing the cranberry sauce.
Gastroparesis is complication of diabetes, and you might not know this — we certainly didn't — but it effects about one in five PWDs! Although it can be caused by many other things, diabetes is a very common cause. In this case, it is a form of diabetic neuropathy. We usually think of neuropathy as impacting just the body's extremities, like the hands and feet, but gastroparesis is similar nerve damage that takes place in your stomach. Yuck!
We did our usual "due diligence" research for our current 411-info series on diabetes complications, and learned a lot about this Yuck. First off, we discovered that gastroparesis literally means "stomach paralysis" because the stomach has difficulty emptying during digestion. Normally, digestion is aided by the vagus nerve, which helps churn your food into small pieces, before it's mixed with enzymes and acid in your stomach to break the food down. But with gastroparesis, the vagus nerve is damaged, so the food is slooowly churned and digestion takes far longer than it should.
Because food is absorbed more slowly and unpredictably, dosing insulin can become incredibly difficult. People with gastroparesis often experience hypoglycemia right after a meal, because the food hasn't reached the digestive system yet, and then hyperglycemia later on because the food has entered the bloodstream after the insulin is mostly finished working. Folks with gastroparesis might need to take their insulin after eating instead of before, and insulin might also need to be given more often or only when blood sugar starts to rise. You'll want to work with your endocrinologist as well as an gastroenterologist (yup, they have specialists for this!) to figure out the best times to take your insulin.
It's sort of a catch-22 with gastroparesis: high blood sugar damages the nerves in the stomach which causes gastroparesis, but then gastroparesis makes it more difficult to control your blood sugars. Argh!
The symptoms are all pretty gross and uncomfortable:
- abdominal pain
- feeling full after just a few bites of a meal (and not from Symlin!)
- weight loss
If you're experiencing these symptoms, then you probably want to go get properly examined by one of those gastroenterologists, doctors specializing in digestive disorders. There are actually many ways to diagnosis gastroparesis, from drinking or eating barium, which allows your stomach to be X-rayed, to using different types of scans to measure the muscular activity of your stomach. (Sometimes they hide the barium in a beefsteak meal - not kidding!)
If you're hesitant about getting looked at by a doctor, listen to this: if your food stays in your stomach for too long, a nasty ball of food called a bezoar can starting building in your stomach. This can worsen your nausea and vomiting and can sometimes even develop into a complete blockage between the stomach and the small intestine, requiring hospitalization. Yikes! There are treatments for bezoars that can break up the mass, but folks who are treated often have to suffer through months of a liquid diet. So trust us: you do not want to sit around and wait if you think you might have gastroparesis!
Once you have a concrete diagnosis, you can start doing something about your upset tummy. Like many other diabetes complications, there is no cure, but there are ways to treat it. Minor cases can be treated with just dietary changes. Focusing on eating low-fat foods and smaller meals gives the stomach less work to do and eases the digestion process.
Beware that some healthy nutrients can also cause a problem for people with gastroparesis, like fiber. Fiber helps food move along in the intestines, but it has the opposite effect in the stomach. Patients are often recommend to stick to low-fiber foods, like cooked fruits and vegetables, fish, chicken, yogurt, refined breads and grains. Liquid meals are also often recommended for people with gastroparesis, because it provides the necessary nutrients but the stomach doesn't have to work quite so hard.
More severe cases of gastroparesis might require medication. Two common drugs that help with digestion are Reglan and Erythromycin. Both of them help stimulate muscle contraction in the abdomen. Reglan also helps with the related vomiting and nausea, but it can cause diarrhea (another yuck!). Erythromycin is an antibiotic, and keep in mind that patients can develop a resistant bacteria from being on an antibiotic for too long.
Eating with diabetes is certainly a challenge all on its own, and adding gastroparesis to the mix only makes things harder. But we can't think of anything worse than having a lump of undigested food lodgegd in our stomachs, so please see a doctor if you think you might have gastroparesis. We certainly can't imagine having a liquid Thanksgiving Day dinner!
And if you've been living with gastroparesis and diabetes, please share some of your wisdom here...