Diabetes and digestive problems commonly go hand-in-hand. Many people with diabetes experience digestive problems, such as constipation, bloating or nausea. Some of these symptoms may be due to diabetes itself, or side effects of medications you are taking. These symptoms could also be due to a common digestive condition for people with diabetes, called gastroparesis.
What is gastroparesis?
Gastroparesis (also called 'delayed gastric emptying') is a chronic disorder of the digestive tract, that causes food to remain in the stomach for a longer period of time than it should. As a result, the food sits in the stomach undigested, and can cause many of the symptoms or digestive problems you may be experiencing. Gastroparesis affects around 27-58% of people with type 1 diabetes and around 30% of those with type 2 diabetes.
What causes gastroparesis?
Gastroparesis is caused by damage to the vagus nerve, which controls the movement of food through the digestive tract. This nerve damage can occur as a result of long periods of high blood sugar in people with type 1 or type 2 diabetes. Chronically high blood sugar levels can also damage blood vessels that supply nerves and organs with nutrients and oxygen, including the vagus nerve and digestive tract, which also contributes to gastroparesis. Diabetes is the most common known cause of gastroparesis.
What are the symptoms of gastroparesis?
When food isn’t digested normally, it remains inside the stomach, causing digestive symptoms. There can be a wide range of symptoms, which may be mild or severe. Some people experience multiple symptoms whereas others may only show one or two.
Signs and symptoms can include:
- Upper abdomen pain
- Feeling full early when eating
- Weight loss
- Stomach bloating
- Appetite loss
- Gastroesophageal reflux
- Stomach spasms
- High/low blood glucose levels
If you experience any of these symptoms on a regular basis, you should talk with the doctor.
What are the complications of gastroparesis?
Some potential complications of gastroparesis include:
- Bacterial overgrowth from fermented food.
- The formation of bezoars, which are solid masses of undigested food, which can block food from entering the small intestine. Bezoars can cause stomach obstruction which can result in significant pain for the individual.
- Swings in blood sugar. When food that has been delayed in the stomach is finally absorbed in the small intestine, blood glucose levels rise. This makes blood glucose management difficult.
What is the treatment for gastroparesis?
Gastroparesis is a chronic condition that cannot usually be cured. However, it can often be kept under control to minimize symptoms and complications.
Once the diagnosis of gastroparesis is made, treatment options may include dietary changes, medications, and insulin.
1. Dietary changes:
- Avoidance of high-fibre and high-fat foods as they take longer to digest
- Eating smaller meals throughout the day (for example 6 small meals instead of 3 large meals)
- Eating more slowly
- Eating blended or more liquid foods if needed
- In very severe cases, feeding tubes and intravenous (IV) feeding may be required
Despite these recommendations, no changes should be made to your meal plan without your diabetes team’s direction.
There are medications used to improve the movement of food through the stomach and gastrointestinal tract. Your doctor may recommend one of these medications to help improve your digestive symptoms.
If you are on insulin, your doctor may adjust your insulin regimen. They may recommend:
- Taking insulin more often
- Changing the type of insulin you use
- Taking insulin after meals instead of before
- Checking blood glucose levels after eating
If you have diabetes and are experiencing digestive problems, it is important to talk to your diabetes team. If you have been diagnosed with gastroparesis, please share your experiences in the Forums section of the website. Other members of the community will be interested to learn from your situation.