Diabetes and Gastroparesis

Gastroparesis (also called delayed gastric emptying) is a progressive disorder that causes food to remain in the stomach for longer than normal periods. Because the nerves that move food through the digestive tract are damaged, the muscles do not work as they normally would. As a result, food often sits in the stomach undigested.

Causes

People who have gastroparesis have damage along their vagus nerve, a long cranial nerve that extends from the brain stem to the abdominal organs, including those of the digestive tract. As in other forms of diabetic neuropathy, damage to the vagus nerve impairs nerve function, and in this case digestion is impaired because the impulses needed to churn food are slowed or stopped. Gastroparesis is difficult to diagnose, and frequently missed in patients, therefore the prevalence of gastroparesis in people with diabetes ranges widely in studies between 5-65%.

Gastroparesis is more common in those who have been diagnosed after many years of high, uncontrolled blood glucose levels. Extended periods of high glucose in the blood cause chemical changes in the nerves throughout the body. Consistently high blood glucose eventually damages the vessels that supply the body’s nerves with nutrition and oxygen, including the vagus nerve, which ultimately leads to gastroparesis. 

Because gastroparesis is a progressive disease, and some of its symptoms like chronic heartburn or nausea seem common, you may not realize that you have the disorder.

Symptoms

The following are gastroparesis symptoms:

  • heartburn
  • nausea
  • vomiting of undigested food
  • early fullness after a small meal
  • weight loss
  • bloating
  • loss of appetite
  • blood glucose levels that are hard to stabilize
  • stomach spasms
  • acid reflux

Gastroparesis symptoms may be minor or severe, depending on the damage to the vagus nerve. Symptoms can also flair up after the consumption of high-fiber or high-fat foods, all of which are typically slow to digest.

Complications

When food isn’t digested normally, it can remain inside the stomach whole, where it has the potential to cause the formation of bacteria due to fermentation. Undigested food can also form solid masses called bezoars that may contribute to nausea, vomiting, and possibly obstruction of the small intestines. 

Gastroparesis presents significant problems diabetics because delays in digestion make controlling blood glucose more difficult. Because the disease makes the digestion process hard to track, glucose readings for diabetics with gastroparesis are often too high or too low, and therefore more difficult to control. If you have erratic glucose readings, share them with your doctor along with any other symptoms you’ve experienced. 

Gastroparesis is a chronic condition, and having the disorder can feel overwhelming. Going though the process of making dietary changes and trying to control blood sugar levels while feeling sick and nauseated to the point of vomiting is exhausting. Those with gastroparesis often feel frustrated and depressed.

Risk Factors

Female diabetics are disproportionately at risk for developing gastroparesis. Other conditions can compound your risk of developing the disorder, including previous abdominal surgeries and/or a history of eating disorders.

Diseases and conditions other than diabetes can cause gastroparesis, such as viral infections, medications that slow digestion, acid reflux disease, and smooth muscle disorders. Other illnesses that may cause gastroparesis symptoms include Parkinson’s disease, chronic pancreatitis, cystic fibrosis, kidney disease, and Turner’s syndrome. Sometimes gastroparesis has no known cause, even after extensive testing.

Prevention and Treatment

People with gastroparesis should avoid eating raw foods, broccoli, oranges, rich dairy products like whole milk and ice cream, and carbonated beverages. Doctors also recommend eating smaller meals and more blended foods. It is also important to keep yourself properly hydrated, especially if vomiting is among your symptoms.

There is no treatment to cure gastroparesis; it is a chronic condition that can usually be successfully managed with dietary restrictions, oral medications, and proper control of blood glucose, including adequate insulin if your type 2 diabetes is insulin dependent. In serious cases, your doctor may help you switch to a liquid diet.

Gastric electrical stimulation is another possible treatment for severe cases of gastroparesis, by which a device surgically implanted in the abdomen, and delivers electrical pulses to the nerves and smooth muscle of the lower part of the stomach. This may reduce nausea and vomiting in patients with gastroparesis.

In the most severe cases, long-term gastroparesis sufferers may use feeding tubes and liquid food for nutrition.