Complications of Diabetes - Gastroparesis

What is it?
    About 20 percent of the people with Type 1 diabetes develop this disorder in which the stomach takes too long to empty. People with Type 2 diabetes get it also, but less often. Diabetes damages the vagus nerve, which is the nerve that keeps food moving through the digestive tract. Gastroparesis can cause food to harden into solid masses and can cause blockages and bacteria problems. The fact that the stomach isn't working properly can also disturb the absorption of glucose and make it harder to control blood sugar.

Symptoms of Gastroparesis
     You should let your doctor know if you have these symptoms of gastroparesis:

• Nausea
• Vomiting
• An early feeling of fullness when eating
• Weight loss
• Abdominal bloating
• Abdominal discomfort

How is it diagnosed?
    You may have a test involving drinking or eating barium, a substance that will help your doctor actually see whether your stomach is working properly. You also might eat a food with a slightly radioactive substance that will show up on a scan. This will produce an image that your doctor can see. There is also a test that measures electrical and muscular activity in the stomach. It involves having a tube inserted through the throat and into the stomach. The tube has a wire that can measure how your stomach is working and digesting. Your doctor might also use a kind of scope via the esophagus to look at the lining of the stomach.
Treatment
    The primary treatment goal for gastroparesis is to regain control of blood glucose levels. Your doctor may re-adjust your insulin level and treat the gastroparesis with medication. Your doctor may also have you work with a dietitian to change your diet, and you may be asked to eat six small meals a day rather than three large ones. Other options are parenteral nutrition which means nutrition will be delivered directly into your bloodstream instead of by eating or a jejunostomy, which is a feeding tube. Both of these treatments are usually temporary.
Several drugs are used to treat gastroparesis, including:

• Metoclopramide (Reglan) - stimulates contractions of the stomach muscle to move food along
• Erythromycin - an antibiotic that has similar effects as Reglan
• Antiemetics - used to reduce nausea and vomiting.

     Your doctor will prescribe medication or change your insulin dosing to help combat the effects of gastroparesis. It is a chronic condition, so treatment is aimed at regaining control of blood glucose levels.


Changes in Eating Habits Can Help Control Gastroparesis
     Your doctor or dietitian will give you specific instructions. Their recommendations may include:

• Eat 6 small meals a day instead of 3 large ones. If less food enters the stomach each time you eat, it may not become overly full.
• Try several liquid meals a day until your blood glucose levels are stable and the gastroparesis subsides. They provide all the nutrients in solid foods, but can pass through the stomach faster.
• Avoid fatty and high-fiber foods. Fat naturally slows digestion, and fiber is difficult to digest.
• Avoid some high-fiber foods such as oranges and broccoli which contain material that cannot be digested. The indigestible parts will remain in the stomach too long and may form a solid mass called a "bezoar." This can be dangerous if bezoars block the movement of food into the small intestine.