Gastroparesis and Diabetics

What is it?
Gastroparesis is a disorder in which the stomach takes too long to empty its contents. Gastroparesis is most often a complication of type 1 diabetes. At least 20 percent of people with type 1 diabetes develop gastroparesis. It also occurs in people with type 2 diabetes, although less often.

Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Diabetes can damage the vagus nerve if blood glucose (sugar) levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.

Symptoms of gastroparesis are:
Nausea
Vomiting
An early feeling of fullness when eating
Weight loss
Abdominal bloating
Abdominal discomfort.
These symptoms may be mild or severe, depending on the person

Complications of Gastroparesis
If food lingers too long in the stomach, it can cause problems like bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Gastroparesis can make diabetes worse by adding to the difficulty of controlling blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person's blood glucose levels can be erratic and difficult to control.

Major Causes of Gastroparesis
Diabetes.
Postviral syndromes.
Anorexia nervosa.
Surgery on the stomach or vagus nerve.
Medications, particularly anticholinergics and narcotics (drugs that slow contractions in the intestine).
Gastroesophageal reflux disease (rarely). Smooth muscle disorders such as amyloidosis and scleroderma. Nervous system diseases, including abdominal migraine and Parkinson's disease. Metabolic disorders, including hypothyroidism.

Treatment
The primary treatment goal for gastroparesis related to diabetes is to regain control of blood glucose levels. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding. It is important to note that in most cases treatment does not cure gastroparesis--it is usually a chronic condition. Treatment helps you manage the condition so that you can be as healthy and comfortable as possible.

Meal and food changes
Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis is corrected. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid fatty and high-fiber foods. Fat naturally slows digestion--a problem you do not need if you have gastroparesis--and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Source:  NIDDK