Does your blood sugar peak hours after a meal or are your levels erratic? It could be a problem with digestion, such as gastroparesis. This is a condition that is sometimes referred to as delayed gastric emptying. Digestion is slowed because of nerve damage that can cause partial paralysis of the stomach. While there may be other causes, diabetes is the most common. Delayed gastric emptying can occur in 30-50% of people with diabetes.
Poor management of diabetes with high glucose levels or having had diabetes for a long time can cause damage to the vagus nerve and can cause a chronic form of gastroparesis. The vagus nerve controls muscles in the digestive tract that help move food through. When the nerves and muscles do not work properly, food does not move or moves slowly through the digestive system. This condition seems to occur more often in females. Gastroparesis can present a challenge to diabetes management.
Other Causes Besides Diabetes
Other causes for gastroparesis include viral infections, some medications, surgery, anorexia, bulimia, gastroesophageal reflux disease (GERD), hypothyroidism, smooth muscle disorders, and diseases of the nervous system.
Complications Caused by Gastroparesis
When you have diabetes, you are usually asked to check your sugar 1-2 hours after you have eaten a meal. If you take insulin, you need to time your insulin injection according to when your blood sugar levels peak. When gastric emptying is delayed, your blood sugar levels can rise and peak later than expected and be unpredictable.
Food that stays too long in the stomach and ferments can cause overgrowth of bacteria. Food can also become hardened and form masses called bezoars that can cause obstructions and nausea and vomiting.
Other complications include malnutrition, fatigue, and weight loss from vomiting and reduced appetite.
Symptoms of Gastroparesis
- Vomiting (mostly undigested food)
- Nausea (chronic or morning nausea)
- Feeling of fullness after eating a small amount
- Poor appetite
- Bad breath
- Erratic blood sugar levels
- Weight loss
- Stomach spasms
- Abdominal bloating or pain
- Gastroesophageal reflux
Diagnosis of gastroparesis is based on how long it takes the stomach to empty. Symptoms can be mild or severe but this does not necessarily indicate the severity of the condition. A person can have mild symptoms yet have a severe case of gastroparesis. A person without many symptoms may have erratic blood sugar levels, poor absorption of medications, and digestive blockages.
Other reasons for your symptoms should be ruled out. This may be done with an upper endoscopy, which allows the doctor to check the condition of the stomach lining. An ultrasound can help rule out causes such as gallbladder disease and pancreatitis. Laboratory tests can be used to assess other causes, such as poor thyroid function and irregular electrolyte levels.
Your doctor may perform tests that help to visualize gastric emptying and help to rule out obstructions. In these tests, you'll consume food or liquid that contains a substance that can be visualized via x-ray or by other means. These tests may include barium x-ray, barium beefsteak meal, or a radioisotope gastric-emptying scan. A small device called a SmartPill is also available, which can be swallowed and collects information as it passes through the digestive tract.
Other tests include gastric manometry where a tube is inserted through the mouth to the stomach to measure electrical activity and muscular movement during digestion. A breath test can also be utilized to indicate how fast the stomach empties.
- Eating smaller, more frequent meals may help to avoid too much food in the stomach at one time. Your doctor may ask you to eat six small meals a day. Liquid meals may be prescribed until there is improvement. Liquids pass through the digestive system more easily while providing much needed nutrition.
- Eliminate or reduce high-fat and high-fiber foods. These foods can further slow digestion.
- Eliminate or reduce foods that increase bowel activity. These foods include milk products, high-fiber foods, spicy foods, prune juice, and caffeine.
- Change insulin regimen if you take insulin. Your doctor may ask you to take insulin after meals and more often. This must be done with your doctor's guidance. You will need to check your blood sugar levels more often as per your doctor's instructions.
- Get blood sugar levels in control.
- Medications, such as metoclopramide and erythromycin, may be prescribed. Medications for other conditions are sometimes used, such as Viagra, mirtazapine, or Botox injection.
- In very severe cases, a feeding tube may be inserted into the small intestine allowing special nutrients to be delivered while bypassing the stomach altogether.
- Parenteral nutrition is an alternative to a jejunostomy. If this treatment is used, nutrients are delivered right into the bloodstream via a catheter placed in a chest vein.
- An implanted gastric neurostimulator is a type of "stomach pacemaker" that is battery operated and implanted surgically to aid in digestion.
The dietary changes necessary to improve gastroparesis may seem to run counter to the dietary recommendations for diabetes management. For example, when you have diabetes, it is recommended you eat whole-grain high-fiber foods -- however, you may be asked to avoid these foods for gastroparesis treatment. You will need to work with your doctor and diabetes care team to come up with an optimal diet plan and diabetes regimen to manage both diabetes and gastroparesis.
Gastroparesis. American Diabetes Association. Accessed: April 5, 2012. http://www.diabetes.org/living-with-diabetes/complications/gastroparesis.html
Gastroparesis. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed: April 10, 2012. http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/
Tonzi MSN NP CGRN, Martha K; Fain PhD RN MC-ADM, FAAN, James. "Understanding Gastroparesis: A Case Study." Gastoenterology Nursing July/August 2002 25(4):154-160