Diabetic gastroparesis is a digestive disorder that happens to people with diabetes. It makes your stomach empty slowly and causes uncomfortable symptoms. This condition can cause various symptoms like bloating, nausea, heartburn, and complications like hypoglycemia and diabetic ketoacidosis due to the wide glycemic fluctuations that can occur. This happens because the nerves in your stomach get damaged, especially if you've had diabetes for a long time. High blood sugar levels in diabetes can harm these nerves over the years. Knowing why and how this happens is essential for treating and improving the lives of people with this condition. 

Key Facts

  • Diabetic gastroparesis is often caused by nerve damage from diabetes, leading to symptoms like nausea, vomiting, and blood sugar fluctuations.
  • Risk factors include long-standing diabetes, smoking, and certain medications.
  • Diagnosis involves tests like ultrasounds and X-rays, alongside symptom assessment.
  • Treatment includes managing blood sugar, eating smaller meals, taking specific medications, and sometimes using devices to aid digestion.
  • Early detection and management are vital for living well with this condition.

Causes and Risk Factors

In most cases, the primary cause of gastroparesis is unknown - This situation is known as idiopathic gastroparesis. However, the most recognized underlying cause is diabetes. This happens when the vagus nerve controlling the stomach muscles is damaged or not functioning properly. During a normal digestion process, the muscles in your stomach contract to help move food through your digestive system. In individuals with diabetes, high blood sugar levels over an extended period can lead to nerve damage, affecting the stomach's ability to contract and move food through the digestive system efficiently. Consequently, your stomach fails to empty properly, causing a prolonged retention of food within the stomach.

Other possible causes of gastroparesis include viral infections, autoimmune diseases, and certain medications.

Some common risk factors of gastroparesis include

  • Undergoing gastrectomy (surgery to remove part of the stomach),
  • Undergoing esophageal surgery
  • Using anticholinergic medicines that block nerve signals
  • Having systemic sclerosis
  • Parkinson's disease, multiple sclerosis, and related nervous system disorders.
  • Having an underactive thyroid (hypothyroidism) can impact the function of various organs, including the digestive system, and may contribute to gastroparesis.
  • Having type 2 diabetes for more than 10 years.
  • Smoking has also been associated with delayed stomach emptying, and individuals who smoke may have an increased risk of developing gastroparesis.

Symptoms of Diabetic Gastroparesis

Diabetic gastroparesis presents specific symptoms, and recognizing them is crucial for early diagnosis and effective management.

Illustration Showing The Symptoms Of Diabetic Gastroparesis

Common symptoms include:

  • Nausea and Vomiting: Individuals with gastroparesis often experience persistent nausea and vomiting, especially after meals.
  • Abdominal Pain: Discomfort and pain in the abdominal region may occur due to delayed stomach emptying and increased pressure.
  • Bloating and Belching: People with gastroparesis tend to feel bloated and belch more often than normal.
  • Feeling Full Quickly: A feeling of fullness even after consuming small amounts of food is a characteristic symptom of gastroparesis.
  • Feeling Full for Extended Periods: With gastroparesis, you don't only feel full quickly but also have food in your stomach for a very long time.
  • Weight Loss: The inability to eat a normal amount of food can lead to unintentional weight loss.
  • Fluctuations in Blood Sugar Levels: For people with diabetes, gastroparesis can make it challenging to predict and manage blood sugar levels, as the absorption of nutrients is delayed.

It's important to note that some medications for narcotic pain, some antidepressants, and some anticholinergics may delay gastric emptying and result in symptoms similar to gastroparesis. Such medicines do not cause gastroparesis; they can worsen the symptoms should you take them with the condition.

Complications and Long-Term Effects

Diabetic gastroparesis, if left untreated or poorly managed, can lead to many complications and long-term effects that can impact your health and quality of life. Here are some potential complications associated with diabetic gastroparesis:

Illustration Of Complications Of Diabetic Gastroparesis
  • Nutritional Deficiencies: Delayed stomach emptying can hinder the absorption of essential nutrients, leading to malnutrition. Over time, this can result in deficiencies of vitamins and minerals, affecting overall health.
  • Blood Sugar Fluctuations: Gastroparesis can complicate predicting and controlling blood sugar levels. The unpredictable absorption of nutrients from the stomach can lead to both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar), making diabetes management more difficult. When blood glucose levels drop too low too often, complications like shakiness, dizziness, loss of consciousness, seizures, and diabetic coma may occur. And when sugar levels stay too high, you may experience complications like eye damage, diabetic neuropathy, foot complications that can lead to amputation, ketoacidosis, and kidney issues.
  • Dehydration: Persistent vomiting, a common symptom of gastroparesis, can lead to dehydration. In severe cases, dehydration can result in electrolyte imbalances and other complications.
  • Gastrointestinal Obstruction: The accumulation of undigested food in the stomach may lead to the formation of bezoars (solid masses), causing partial or complete blockages in the gastrointestinal tract.
  • Bacterial Overgrowth: Stagnant food in the stomach can create an environment conducive to bacterial overgrowth, leading to infections and further complications.
  • Esophageal Issues: Gastroparesis can contribute to gastroesophageal reflux disease (GERD) and esophageal inflammation, increasing the risk of esophageal ulcers, Barrett's esophagus, and even esophageal cancer.
  • Psychosocial Impact: Living with the chronic symptoms and uncertainties associated with gastroparesis can have emotional and psychological effects, leading to stress, anxiety, and depression.
  • Reduced Quality of Life: Chronic symptoms such as nausea, vomiting, and abdominal pain can significantly impact an individual's daily life, causing discomfort, fatigue, and a diminished overall quality of life.

If you have diabetic gastroparesis, you should proactively work with your healthcare provider to manage your symptoms and reduce complications. Consistent monitoring, adherence to treatment plans, and open communication with a doctor are crucial to minimizing long-term effects.

Diagnosis and Medical Assessment

To diagnose diabetic gastroparesis, your doctor will consider your symptoms and conduct specific diagnostic tests to confirm the presence and severity of the condition. Given that diabetes is a common underlying cause of gastroparesis, healthcare professionals will often assess patients with diabetes who present related gastrointestinal symptoms.

Illustration On Diagnosis And Medical Assesment For Diabetic Gastroparesis

Here are some measures your doctor may take to diagnose gastroparesis if they suspect you have it:

Physical Examination

A thorough physical examination will be conducted, with attention to signs of malnutrition, abdominal tenderness, and other indicators related to gastroparesis.

Ultrasound

Your doctor may have you undergo an ultrasound examination as one of the initial steps to a diagnosis. This enables sound waves to show the inside of your abdomen and determine whether issues with your internal organs, like kidneys, might be behind your symptoms.

Gastric Emptying Scintigraphy

To diagnose gastroparesis, you may eat a meal containing a small amount of radioactive substance. A special camera tracks the movement of this material through the digestive system in a process that may take up to 4 hours. This test evaluates how ingested food moves through your stomach and gastrointestinal (GI) tract. Delayed gastric emptying indicates the presence of gastroparesis.

Upper Gastrointestinal (GI) Endoscopy:

An upper GI endoscopy may be performed to rule out other gastrointestinal conditions. For this procedure, your doctor will use a tiny camera on the end of a long, flexible tube to examine your esophagus, stomach, and duodenum.

Barium X-ray Examination

Your doctor may carry out a barium X-ray to investigate symptoms like gastric outlet obstruction. For this examination, you need to fast for 12 hours, after which you will ingest a liquid containing barium, followed by an abdominal X-ray. The barium coats the esophagus, stomach, and small intestine, making them visible on the X-ray. While individuals usually have an empty stomach during this test, those with gastroparesis may still retain some food.

Wireless Motility Capsule

In some cases, a wireless motility capsule may be used to measure the contractions and movement of the digestive tract.

For this examination, you may be asked to swallow a small electronic device (SmartPill), which will pass through the digestive tract while recording and storing data. The capsule is then later defecated. By analyzing the information provided by the SmartPill, your doctor can assess the rate of stomach emptying and diagnose diabetic gastroparesis.

Electrogastrography (EGG):

EGG measures the electrical activity of the stomach muscles, providing information about gastric contractions and motility. To achieve this, you will wear electrodes on your skin.

NOTE: Individuals with diabetes experiencing gastrointestinal symptoms should seek prompt medical attention for a thorough evaluation and appropriate management. Once a diagnosis of diabetic gastroparesis is confirmed, your healthcare provider will work with you to develop a personalized treatment plan. This plan may include dietary modifications, medication adjustments, and lifestyle changes to manage symptoms effectively and improve your quality of life. Regular follow-up visits are crucial to monitor progress and make necessary adjustments to the treatment plan.

Treatment Options

While there is no cure for diabetic gastroparesis, several strategies can help manage symptoms and improve overall well-being:

Blood Sugar Monitoring

Regular monitoring of blood sugar levels is crucial for individuals with diabetic gastroparesis. Your doctor may have to adjust insulin or medication doses based on your meal timing to help you achieve stable blood sugar levels.

Illustration Of Treatment Options For Diabetic Gastroparesis

Dietary Modifications

Adopting a diet with smaller, more frequent meals that are low in fat and fiber can ease the burden on the digestive system. Liquids and pureed foods will be easier to digest than solid foods. You can also opt for well-cooked vegetables instead of raw ones and avoid alcohol and carbonated drinks.

Medications

Medications like prokinetics can help stimulate stomach contractions, and over-the-counter antihistamines like Dimenhydrinate (Dramamine) can reduce nausea and vomiting. Your doctor may also discontinue drugs that may worsen gastroparesis, including antidepressants, high blood pressure drugs, and certain diabetes treatments like GLP-1 receptor agonists.

Nutritional Support

In severe cases where oral intake is compromised, nutritional support may be necessary through enteral (a feeding tube placed into the stomach or small intestine) or parenteral nutrition (a tube inserted into a vein).

Lifestyle Changes

Lifestyle changes like avoiding lying down after meals, staying hydrated, and engaging in light physical activity after eating can promote digestion and reduce gastroparesis symptoms and complications.

Gastric Electrical Stimulation

Sometimes, a device that delivers electrical impulses to the stomach muscles may be implanted to improve gastric motility. This device will significantly reduce symptoms like nausea and vomiting.

What Foods Should Diabetics With Gastroparesis Avoid?

When managing gastroparesis with diabetes, it's typically recommended to avoid certain foods that can worsen the symptoms. According to studies, these are foods to avoid;

  • Avoid Fatty Foods: Avoid fried foods, fatty meats, creamy sauces, and full-fat dairy, as they can slow digestion and worsen symptoms. 
  • Eat Less Fiber: Reduce your intake of whole grains, raw veggies, and fruits with skins and seeds, as these are hard to digest and can cause discomfort. 
  • Don't Drink Bubbles: Avoid sodas and sparkling water, as they make you feel bloated and uncomfortable. 
  • Go Easy on Alcohol: Limit alcohol or skip it altogether because it can irritate your stomach and slow down digestion. 
  • Eat Smaller Meals: Instead of big meals, have smaller ones more often to avoid overwhelming your stomach. 
  • Skip Spicy Stuff: Avoid spicy foods because they irritate your stomach and worsen your heartburn.
  • Cut Down on Caffeine: Drink less coffee, tea, and energy drinks, as they can increase stomach acid and cause tummy problems. 
  • Stick to Easy Foods: Eat foods that are easy to digest, like cooked veggies, lean meats, low-fat dairy, and well-cooked grains to help manage your symptoms better.

Conclusion

While gastroparesis can potentially be a hard one for people with diabetes, with proper management, its effects can be minimized. Working closely with healthcare providers, including endocrinologists, gastroenterologists, and dietitians, is essential for developing a detailed treatment plan. By adopting lifestyle changes, making dietary adjustments, and utilizing medical interventions when necessary, those with diabetic gastroparesis can enhance their quality of life and better control their diabetes. Early diagnosis and proactive management are key factors in achieving optimal outcomes for individuals with this condition.

Sources

At Diabetic Me, we are committed to delivering information that is precise, accurate, and pertinent. Our articles are supported by verified data from research papers, prestigious organizations, academic institutions, and medical associations to guarantee the integrity and relevance of the information we provide. You can learn more about our process and team on the about us page.

  1. National Library of Medicine Gastrointestinal Involvement in Systemic Sclerosis
  2. National Library of Medicine Efficacy of Pro-Kinetic Agents in Type 2 Diabetes Mellitus Patients With Gastroparesis Using Lactulose Hydrogen Breath Testing: A Randomized Trial
  3. National Library of Medicine Efficacy of Pro-Kinetic Agents in Type 2 Diabetes Mellitus Patients With Gastroparesis Using Lactulose Hydrogen Breath Testing: A Randomized Trial
  4. National Library of Medicine Diabetic Gastroparesis: A Review
  5. National Library of Medicine Gastroparesis-Related Symptoms in Patients With Type 2 Diabetes Mellitus: Early Detection, Risk Factors, and Prevalence
  6. NIH Symptoms & Causes of Gastroparesis

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About the Author

Ely Fornoville

Hi, I'm Ely Fornoville, and I am the founder of Diabetic Me. Being a type 1 diabetic since 1996, I developed a passion to help people learn more about diabetes. I write about diabetes and share stories from other diabetics around the world. I currently use a Medtronic Guardian 4 CGM and a MiniMed 780G insulin pump with Humalog insulin.

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