Diabetic Gastroparesis


Diabetic gastroparesis

Key Takeaways

  • Diabetes is the most commonly known cause of gastroparesis, a digestive condition.
  • Gastroparesis results from nerve damage associated with high blood sugar. It slows down or stops muscle movement in the stomach, so food does not empty as it should.
  • Nausea, heartburn, or bloating are symptoms of gastroparesis in patients with diabetes.
  • Because it impacts nutrient absorption, if left untreated, gastroparesis can lead to malnutrition.
  • Frequent vomiting, often causing dehydration, is an unpleasant symptom of diabetic gastroparesis.

WHAT IS DIABETIC GASTROPARESIS?

Diabetic gastroparesis results in patients struggling to manage diabetes, stemming from dysfunction in the autonomic nervous system, neurons, and specialized pacemaker cells of the stomach and intestine, as well as the smooth muscle cells of the GI tract. 

Medical professionals believe that type 1 diabetes likely boosts the odds of developing gastroparesis. In fact, diabetes is the most commonly known cause. Older adults and women also face a higher risk.

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What is Gastroparesis?

Gastroparesis is a digestive disorder that keeps the stomach from emptying properly, often due to damage of the nerves controlling the stomach muscles. Symptoms include nausea and feelings of fullness, even after eating very little. Your gastroenterologist may recommend medication or diet changes to bring relief. 

Gastroparesis: Cause, Symptoms, Diagnosis & Treatment

What is Diabetes?

Diabetes is a chronic condition that impacts how the body converts food to energy. When functioning properly, the body breaks down food into sugar (glucose) and then releases it into the bloodstream. When blood sugar rises as a result, this signals the pancreas to release insulin.

For more helpful resources on diabetes: 

CDC | Diabetes
American Diabetes Association | Diabetes
National Library of Medicine | Gastrointestinal Disorders in Diabetes

FOOD AND DRINKS TO AVOID

Here at Charleston GI, our board-certified gastroenterologists recommend avoiding the following foods and beverages to keep unpleasant symptoms at bay:

  • Fatty foods: Skip foods with a high fat content and instead choose leaner meats and non-greasy options.
  • High-fiber foods: Foods rich in fiber, like raw veggies, whole grains, beans, and nuts, may cause bezoar formations (fiber clumps) that can cause stomach blockages.
  • Hard to chew foods: Steaks, roasts, and foods with tough skins are not only difficult to chew but tough for your body to digest! 
  • Milk and dairy products
  • Alcohol 
  • Carbonated drinks and sugary drinks

Note: Even healthy beverages should be sipped in small amounts while eating to avoid feeling full.

FOODS TO EAT

While the foods that trigger symptoms vary from one person to the next, these foods are typically tolerated well. Our GI doctors suggest replacing the food and drinks listed above with these options:

  • Lean protein: Choose skinless chicken, turkey, fish, tofu, or eggs that are baked or broiled.
  • Fat-free or low-fat milk and dairy products: Opt for yogurt, cottage cheese, pudding, and custard with a low-fat content.
  • Soup: Select soups that are made using broth or fat-free/low-fat milk.
  • White bread, white rice, white pasta, low-fiber cereals, pretzels, low-fiber crackers.
  • Well-cooked vegetables without skin: Good options include squash, beets, carrots, spinach, potatoes, etc.
  • Non-chunky tomato products: Incorporate smooth tomato sauces, puréed tomatoes, and tomato juice.
  • Soft or cooked fruit without the skins: Snack on applesauce, ripe bananas, and canned or cooked fruit.
  • Decaf tea and coffee: Skip caffeinated drinks if you often experience heartburn.
  • Non-carbonated, sugar-free drinks.

RISK FACTORS 

These factors have been shown to boost the risk of developing gastroparesis:

  • Diabetes
  • Abdominal or esophageal surgery
  • Infection (typically virus-related)
  • Medications that slow stomach emptying (narcotic pain meds, etc.)
  • Scleroderma (a connective tissue condition)
  • Nervous system diseases (Parkinson's disease, multiple sclerosis, etc.)
  • Hypothyroidism (underactive thyroid)

Note: Women are more likely to develop gastroparesis than men.

SYMPTOMS

Because they may point toward a gastroparesis diagnosis, be sure to visit your GI doctor if you are experiencing these symptoms:

  • Heartburn or acid reflux
  • Nausea
  • Vomiting (daily, in severe cases)
  • Trouble managing blood sugar
  • Feeling full quickly when eating
  • Abdominal bloating
  • Poor appetite and unintentional weight loss

COMPLICATIONS

Gastroparesis may result in these complications:

  • Severe dehydration due to frequent vomiting.
  • Malnutrition related to poor appetite or improper nutrient absorption.
  • Bezoars (undigested food that hardens and remains in your stomach).
  • Unpredictable changes in blood sugar levels.
  • Decreased quality of life.

WHEN TO SEE A DOCTOR

There’s no need to suffer in silence. Schedule an appointment with your gastroenterologist if you are experiencing extreme hunger, unintentional weight loss, fatigue, weakness, blurred vision, irritability, and other unexplained mood shifts. 

DIAGNOSTIC TEST 

  • Upper gastrointestinal (GI) endoscopy
  • Imaging tests
  • Lab tests (tests to measure how fast your stomach is emptying its contents to diagnose gastroparesis)

TREATMENT

Following a gastroparesis diagnosis, your Gi doctor may recommend the following treatments:

  • Insulin
  • Medication
  • Diet changes

While there is no cure for gastroparesis, symptoms can be managed – most frequently by getting control of blood sugar levels. This can be done using insulin or oral medications, as well as altering eating habits. In the most severe cases, IV feeding or feeding tubes are required.

Be sure to discuss your current medications with your GI doctor to determine whether you should continue taking them. Some may worsen symptoms, like antidepressants, high blood pressure medications, and certain diabetes treatments.

Exercise and physical activity also cause insulin sensitivity, making it an essential part of diabetes management. Your gastroenterologist may also suggest lifestyle changes like losing weight, preventing blood sugar spikes, reducing stress, and getting more sleep. 

PREVENTION

There is no cure for gastroparesis, but you can alleviate symptoms by adding the following to your daily routine:

  • Keep blood sugar levels within the target range.
  • Eat small, low-fat, low-fiber meals often throughout the day. 
  • Drink plenty of water, ideally six to 10 cups per day.
  • Discuss current medications and supplements with your GI doctor.
  • Limit or avoid drinking alcoholic beverages.
  • Quit smoking.
  • Engage in at least 150 minutes of physical activity every week.

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DIABETES FACTS

Diabetes

  • Total: 37.3 million people have diabetes (11.3% of the US population).
  • Diagnosed: 28.7 million people, including 28.5 million adults.
  • Undiagnosed: 8.5 million people (23.0% of adults are undiagnosed).

Prediabetes

  • Total: 96 million people aged 18 years or older have prediabetes (38.0% of the adult US population).
  • 65 years or older: 26.4 million people aged 65 years or older (48.8%) have prediabetes.

More Facts

  • After almost 2 decades of continual increases, the incidence of newly diagnosed cases of diabetes in the United States decreased from 9.3 per 1,000 adults in 2009 to 5.9 per 1,000 adults in 2019.
  • American Indian or Alaska Native, non-Hispanic Black, Hispanic, and non-Hispanic Asian people are more likely to be diagnosed with diabetes than non-Hispanic White people.
  • During the COVID-19 pandemic, diabetes emerged as an underlying condition that increases the chance of severe illness. Nearly 4 in 10 adults who died from COVID-19 in the United States also had diabetes.
  • Regular eye exams and timely treatment could prevent up to 90% of diabetes-related blindness.
  • Regular foot exams and patient education could prevent up to 85% of diabetes-related amputations.

FREQUENTLY ASKED QUESTIONS

What is the connection between diabetes and gastroparesis?

Diabetes is strongly linked to gastroparesis. In fact, it is the most commonly known cause.

For diabetics, what is the link between gastroparesis and blood glucose levels?

There is a two-way relationship between blood glucose and stomach emptying. Blood glucose levels impact the stomach’s function – and vice versa! Some research even shows that high blood glucose levels increase your odds of developing gastroparesis. Plus, gastroparesis may make it even harder for diabetics to keep their blood sugar levels in check.

What are the gastric symptoms of diabetes?

Delayed stomach emptying or diabetic gastroparesis are the most common symptoms. Improper stomach emptying may cause nausea, vomiting, feelings of fullness, and bloating.

Is diabetic gastroparesis serious?

Many people with gastroparesis experience unpleasant symptoms like nausea and vomiting.  Because many gastroparesis sufferers tend to absorb fewer nutrients than they need, their quality of life is often diminished. Some patients even face life-threatening complications.

Can you live a full life with gastroparesis?

While not life-threatening, gastroparesis symptoms often impact the quality of life. Sufferers may be unable to engage in certain activities or go to work during flare-ups. But when successfully managed, symptoms can be manageable.

Can diabetic gastroparesis go away?

There is no known cure for gastroparesis, but many patients find relief by managing blood glucose levels. This is done by consuming frequent, small meals that are low in fat and fiber. 

Can diabetes cause gastric reflux?

Some research indicates that 40% of people with diabetes also suffer from GERD, indicating a direct link between diabetes and acid reflux. Studies also suggest that diabetic neuropathy – nerve damage due to high blood sugar – may account for GERD symptoms.

Does diabetes cause stomach gas?

Yes, excessive stomach gas and bloating is often associated with diabetes.

What stomach problems do diabetics have?

GI complications of diabetes include gastroparesis, intestinal enteropathy, and nonalcoholic fatty liver disease.

What foods are good for diabetics with gastroparesis?

White bread, white rice, white pasta, low-fiber cereals, pretzels, low-fiber crackers, well-cooked vegetables without skin, smooth tomato sauces and juices, puréed tomatoes, applesauce, ripe bananas, and canned/cooked skinless fruit.

How do you test for gastroparesis?

Your GI doctor may perform lab tests, an upper gastrointestinal (GI) endoscopy, imaging tests, and other tests to measure the rate of stomach emptying.

How do you test for diabetes?

Your gastroenterologist will use a blood test to diagnose diabetes, prediabetes, and gestational diabetes. 

What is the difference between type 1 and type 2 diabetes?

In diabetes type 1, the body's immune system attacks the pancreatic cells tasked with insulin production. In diabetes type 2, the pancreas makes less insulin than it used to, causing the body to become resistant.

What happens if a diabetic person’s sugar levels are too high?

When blood sugar levels spike above normal levels, the extra sugar passes from the blood into the urine. That triggers a process that draws a large amount of fluid from the body. If left untreated, this may result in life-threatening dehydration or a diabetic coma.

What happens if a Type 2 diabetic doesn't eat?

Not eating may cause headaches, but the biggest danger of fasting is very low blood sugar levels (hypoglycemia).

How do I know if I am insulin resistant?

Patients with high blood sugar levels, high triglycerides, high LDL (“bad” cholesterol), and low HDL (“good” cholesterol) may be diagnosed with insulin resistance.

Type 1 diabetes is commonly thought to be caused by an autoimmune reaction in which the body attacks its own healthy cells. People with type 1 diabetes don’t produce adequate insulin and must take it to survive.

What causes insulin resistance?

While a definitive cause has not been identified, those with resistance to insulin often have a family history of type 2 diabetes, are overweight (especially around the middle), or lead sedentary lifestyles. Note: You do not have to be overweight to have insulin resistance. 

What can I do to reverse insulin resistance?

Your GI doctor may recommend increasing your physical activity, losing weight, reducing stress, properly managing blood sugar, and getting more sleep.


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