Over time, diabetes affects many parts of a person’s body. One of these is the vagus nerve, which controls the rate of gastric emptying. When the vagus nerve is damaged, the body’s digestion slows down and food actually stays in the body longer than it should.
This disorder, called gastroparesis, can make you feel nauseous and vomit, which is also detrimental to the patient’s blood sugar stability.
While symptoms of gastroparesis are more common in people who have type 1 diabetes, people with type 2 diabetes can also develop gastroparesis. Most people with gastroparesis have at least a 10-year history of diabetes and other complications associated with the disease.
Symptoms
Patients may experience:
- heartburn or reflux (regurgitation of stomach contents into the esophagus)
- nausea
- Vomiting (in severe cases, this may occur daily)
- Impaired glycemic control
- Feeling full quickly when eating
- Abdominal bloating
- Loss of appetite and weight loss
Complications
Food stays in the stomach for too long, which is bad for the stomach and can lead to the growth of bacteria.
Undigested food can harden and form a mass called a gastric stone. It can block the patient’s stomach, preventing what the patient eats from reaching the small intestine.
Gastroparesis can make it difficult to control the diabetes, and when food ends up in the small intestine from the stomach, the patient’s blood sugar rises.
Vomiting can also make patients dehydrated.
Diagnosis
The doctor will ask about the patient’s symptoms and will do the appropriate physical exams, including a blood glucose test. In addition, the doctor may recommend other tests.
Barium x-ray
Patients drink a liquid (barium) that covers the esophagus, stomach, and small intestine and shows up on an x-ray. This test is also called an upper gastrointestinal (gastrointestinal) barium meal angiogram or barium esophagus meal.
Barium package
After eating a meal with barium, the doctor uses X-rays to see how long it takes the patient to digest the food. This allows the doctor to see how long it takes for the patient’s stomach to empty.
Radioisotope gastric emptying scan
The patient eats food containing radioactive material and then lies under a scanner that detects radiation. If the scan shows that more than half of the food is still in the stomach after 1.5 hours, the patient has gastroparesis.
Gastric manometry
Doctors use a thin tube through the patient’s mouth and into the stomach to measure how fast the patient digests food.
Wireless power capsule: The patient swallows a small capsule with a meal. It measures pressure, temperature, and pH in different parts of the intestine.
Gastric electrogram
Gastric electrograms allow patients to put electrode pads on their skin to measure the electrical activity in the stomach.
Ultrasound examination
The doctor will look inside the patient’s body with the help of sound waves.
Upper gastrointestinal endoscopy
The doctor will put a thin tube (called an endoscope) through the throat to look at the lining of the patient’s stomach.
Gastric or small bowel biopsy
The doctor may need to take a small sample of tissue to confirm the diagnosis.
Treatment
While there is no cure, gastroparesis and its symptoms can be managed.
Control of blood glucose will help. Ask your doctor if you need to change the timing and frequency of insulin use and if you need to check your blood sugar more frequently.
Also, consult your doctor about whether you should stop or replace medications that may worsen gastroparesis. These medications include antidepressants, high blood pressure medications, and certain diabetes treatment medications.
Medications
- Typhenhydramine, an over-the-counter antihistamine helps prevent nausea and vomiting.
- Domperidone, which treats upper gastrointestinal problems associated with gastroparesis.
- Erythromycin, an antibiotic that promotes digestion of food by the stomach.
- Metoclopramide, which promotes muscle movement in the stomach and helps digest food in the stomach. It also prevents nausea and vomiting.
- Ondansetron, which blocks chemicals in the brain and stomach that cause nausea and vomiting.
- Prochlorperazine, which helps with nausea and vomiting.
Surgery
With a method called gastric electrical stimulation, a surgically implanted device sends short, low-energy pulses to your stomach to help prevent nausea and vomiting in patients.
In extreme cases, some patients may need a feeding tube. The surgeon implants a special tube through the patient’s abdominal wall and then directly into the small intestine. The patient “eats” the special liquid food through the tube, and the food goes directly into the small intestine without lingering in the stomach.
Change in diet
For people with diabetes, one of the best ways to help manage symptoms of gastroparesis is to change when and how you eat. By promoting smaller, more frequent meals, you will have less food in your stomach so you don’t feel full. Food will also be easier to digest.
In addition, pay attention to the ingredients. Foods that are liquid and easy to digest are good choices. For example, use applesauce instead of whole apples.
Avoid foods that are high in fat, as they slow down digestion. As for fiber, it takes longer for the body to empty it.