Understanding Diabetic Gastroparesis
Gastroparesis is when food moves through the stomach more slowly than normal. It’s also called delayed gastric emptying. In someone with diabetes, it’s caused by damage to the vagus nerve from ongoing (chronic) high blood sugar.
How to say it
What causes diabetic gastroparesis?
The vagus nerve helps control how food moves through the digestive system. When this nerve is damaged from chronic high blood sugar, the movement of food is slowed down or stopped. Gastroparesis can also be caused by injury to the nerves and smooth muscle cells that line the wall of the stomach and push the food along for digestion.
Symptoms of diabetic gastroparesis
Symptoms can include:
Feeling full after eating a small amount of food
Abdominal pain or cramps
Loss of appetite
High or low blood sugar levels
Diagnosing diabetic gastroparesis
Your healthcare provider will give you a physical exam and ask about your past health. You may have tests such as:
Blood tests. These tests check your blood counts and measure your chemical and mineral (electrolyte) levels.
Upper gastrointestinal (GI) series. This is also called a barium swallow. This test checks your food pipe (esophagus), your stomach, and the first part of your small intestine (duodenum).
Radioisotope gastric-emptying scan. This test lets a radiologist see food in your stomach during the scan. He or she can see how quickly food leaves your stomach.
Gastric manometry. This is also called antroduodenal manometry. This test checks the muscle movement in your stomach and small intestine.
Upper endoscopy. This test looks at the lining or inside of your esophagus, stomach, and duodenum.
Wireless capsule study. For this test, you swallow a wireless capsule that measures stomach emptying.
Scintigraphic gastric accommodation. This test measures your stomach contents before and after a meal. It also checks how well your stomach relaxes after you eat food.
Treatment for diabetic gastroparesis
Your healthcare provider will create a care plan for you that may include:
Taking medicines. You may be prescribed medicine to help with blood sugar levels, help your symptoms like nausea and vomiting, or act on muscles in the digestive system. Your healthcare provider may prescribe a few medicines to see which works best.
Stopping some medicines. Your healthcare provider may tell you to stop taking any medicines that slow digestion.
Changing your diet. Making changes to your eating habits can help control the problem. (See Changing your diet below.)
Gastric neurotransmitter. This device may help control any upset stomach and vomiting. It is put into your body by surgery.
Feeding by IV. In severe cases, you may need surgery to insert a feeding tube. This is also called parenteral nutrition. This is when nutrients are put right into your veins. A tube is put into one of your chest veins. A bag with liquid nutrients or medicine is joined to the tube.
Surgery. In very severe cases, you may need a type of surgery called a jejunostomy. A feeding tube is inserted through the skin on your abdomen into your small intestine. This tube lets nutrients go right into your small intestine instead of your stomach.
Changing your diet
These changes may help reduce the problem:
Eat 6 smaller meals a day instead of 3 large meals.
Have a few liquid meals a day instead of solid food. You may need to do this until your blood glucose levels are stable.
Don’t eat foods high in fat. This includes fried food, fatty meats, and high-fat dairy foods. These can slow your digestion.
Don’t eat foods high in insoluble fiber. This includes beans and many fruits and vegetables. These can be hard to digest.
Talk with your healthcare provider or a dietitian about an eating plan that is best for you.
Possible complications of diabetic gastroparesis
Food that stays in the stomach for too long can cause problems. Food can ferment in the stomach, causing bacteria to grow. Undigested food can harden into lumps called bezoars. These can cause nausea and vomiting. In some cases, they may block food from passing from the stomach to the small intestine. Gastroparesis can make it hard to manage blood sugar levels. It can also cause problems with vitamins and minerals being absorbed into the body. And it can cause problems with keeping a healthy weight.
Living with diabetic gastroparesis
For many people, gastroparesis is a lifelong condition. With diabetes, the main goal is to control your blood sugar levels. Follow up with your healthcare provider as advised. You may need regular visits to manage your health.
When to call your healthcare provider
Call your healthcare provider if you have any of the following:
Severe pain in your abdomen
Inability to keep down food or liquids
Other symptoms as advised by your healthcare provider
December 22, 2017
Diabetic autonomic neuropathy of the gastrointestinal tract. UpToDate.
Fetterman, Anne, RN, BSN,Hurd, Robert, MD