Diabetes

Gastroparesis

Autonomic neuropathies are Diabetes-related complications that affect the nerves controlling the body systems and internal organs. The symptoms of autonomic neuropathy vary according to the site of the problem. Gastroparesis is a form of autonomic neuropathy that affects the stomach and can happen in people with both Type 1 and Type 2 Diabetes.  It is a chronic condition characterized by delayed stomach emptying. This means that the stomach takes a longer time than usual to empty its contents (i.e. food).

Having high blood sugar levels for a long time causes chemical changes to the nerves and blood vessels that supply these nerves with oxygen and nutrients. These changes might damage  the nerves, affecting the function of the muscles of the stomach and intestines. This results in delayed food emptying from the stomach.

Symptoms:

Gastroparesis can cause heartburn, gastroesophageal reflux, nausea, bloating, vomiting, early feeling of fullness when eating, lack of appetite, weight loss, uncontrolled blood sugar levels, spasms of the stomach wall, diarrhea, or constipation. The severity of these symptoms differs from one person to another.
Complications:
When food stays in the stomach for a long period, it can cause bacterial overgrowth as a result of food fermentation. Undigested food becomes hard causing solid masses – called bezoars – which may obstruct the stomach leading to nausea and vomiting. Also, bezoars can be dangerous when they prevent food from leaving the stomach to go into the small intestines.
Gastroparesis makes controlling blood sugar levels difficult as food emptying from the stomach is unpredictable. The longer the food stays in the stomach the more challenging it is to control the blood sugar levels.

Diagnosis:

There are many tests that can be used to diagnose this medical condition. Your doctor will choose the best and the most appropriate method depending on your condition. Remember to discuss the symptoms you have with your doctor. You should put into your consideration that the symptoms you have might be related to different reasons other than gastroparesis; these symptoms are very common with many other conditions.

Treatment:

The main treatment goal for Diabetes-related gastroparesis is to relieve symptoms and control blood sugar levels. Various medications are used to treat gastroparesis; however, it is usually a chronic condition and in most cases treatment does not cure gastroparesis.
Insulin for blood sugar control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. Your Diabetes care team will give you specific advice based on your particular needs. To help you control your blood sugar levels, your Diabetes care team may advise you to try the following strategies:
• Take insulin more often
• Take insulin after your meal instead of before
• Check your blood sugar levels frequently after you eat and take insulin whenever necessary

Medication

Your doctor may try different medications or combinations of medications to find the most effective treatment and help you manage the condition and be as healthy and comfortable as possible.

Dietary considerations

Changing your eating habits may help you control gastroparesis. Your dietitian will give you special instructions based on your symptoms and may try various approaches to help you manage your symptoms. You may be advised to:
• Reduce your meal size but eat more frequently
• Try liquid or semisolid meals until your blood sugar levels are controlled and gastroparesis symptoms have improved
• Avoid high-fat and high-fibre foods because fat naturally slows digestion and fibre is hard to digest
• Chew your food well to reduce the amount of work your stomach has to do

Surgical treatment

Surgical interventions may be needed to manage gastroparesis when other approaches fail. Surgery is usually temporary and is used only if gastroparesis is severe. For example, a feeding tube may be inserted through the skin on the abdomen into the small intestine. Special liquid food is used with this tube.
The feeding tube allows nutrients to be delivered directly into the small intestine, bypassing the stomach altogether to ensure the nutrients are digested and delivered to the bloodstream promptly.
Remember that none of the aforementioned approaches can cure gastroparesis, but they can help relieve symptoms.