Gastroparesis – It's Not a Greek God

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While technical names of medical conditions can be quite intimidating, in the case of gastroparesis it is quite easy to explain. That is a good thing, because nearly 50% of people with diabetes will experience gastroparesis and the condition can have serious effects on glucose levels.

Simply put, gastroparesis is a condition in which the stomach takes too long to digest its contents and move food into the small intestine. The condition results from neuropathy, or damage to the nerves, in the digestive tract.  Gastroparesis and neuropathy can result from high glucose levels over a long period of time.

The signs of gastroparesis can be very uncomfortable and even embarrassing. They include:


  • Heartburn
  • Nausea
  • Vomiting of undigested food
  • Feeling of fullness early in the meal or snack
  • Weight loss
  • Abdominal bloating
  • Erratic blood glucose levels
  • Lack of appetite
  • Gastroesophageal (or acid) reflux
  • Spasms of the stomach wall
  • Hypoglycemia (low glucose) after a meal, followed by high glucose


In some cases the food can harden into lumps or masses called bezoars. If these bezoars block the passage to the small intestine the consequences can be very serious. Another complication is the condition's effect on glucose levels. When glucose levels become erratic or hard to control, this can interfere with your ability to treat your diabetes leading to other long-term complications.

Treatment

In most cases the treatments for gastroparesis do not cure the condition. They treat or relieve the symptoms.  Gastroparesis is a long-term illness that will need to be managed along with your diabetes management regimen. Fortunately, there are ways to treat the problem that can help you to stay healthy and comfortable.

Since the cause of gastroparesis is diabetes, the most important goal of treatment is to control your glucose levels. Testing your glucose often, before and after meals, or using a continuous glucose monitoring device, can give you a much clearer picture of your fluctuating glucose levels and help you better manage your diabetes.

When you use short-acting insulin and intensive insulin therapy, such as an insulin pump, you can adjust insulin doses precisely and quickly. Because the newer fast-acting analog insulin is more predictable, people with gastroparesis can better match insulin delivery to their body's slower digestion rate. By using the bolus features on the insulin pump, insulin can be delivered precisely.  The insulin dose can be spread over a select period of time.

Many patients with gastroparesis find that managing glucose levels is difficult. This is because the slow or unpredictable digestion does not match up with insulin action and duration.  Having a clear picture of exactly how your body is digesting your food and how your insulin is absorbed is crucial to controlling your diabetes.    Improved diabetes control may help to slow the progression of neuropathy, or nerve damage.    

In addition to tighter control, people with gastroparesis can modify their eating habits to try to help their body digest food. Eating smaller meals more often, rather than fewer larger meals can be a big help. Also, carefully choosing high-fiber or hard-to-digest foods, as well as avoiding high fat foods will help with slow stomach emptying.

There are a number of medications that can help the symptoms.   Metoclopramide (Reglan) and domperidone can help with the nausea.  Erythromycin is an antibiotic that can improve stomach emptying.  More information about these drugs and their side effects can be found on the National Institutes of Health website, http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/.

A continuous glucose monitoring device can help you to spot the erratic swings in glucose levels, before they become a serious problem. Trend graphs and alerts can bring your attention to rising or falling glucose before the get too extreme.   With improved glucose control it is possible to get the upper hand on this painful and potentially dangerous condition.  Given the seriousness of gastroparesis, it is very important to discuss your symptoms treatment options with your healthcare professional.

Additional Resources

American Diabetes Association – www.diabetes.org

Gastroparesis and Dysmotilities Association – http://digestivedistress.com/index.htm

National Diabetes Information Clearinghouse (National Institutes of Health) – http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/

dLife For Your Diabetes Life – www.dlife.com