I am sure those of us with diabetes have heard the terms apple and pear shaped body. It seems that people with diabetes are more often apple shape which means that we have a tendency to gain weight in our stomach area as compared to hips, thighs and buttocks which describes the pear shape body. However, this is not what I am referring to today. Diabetic Stomach is used to describe diabetes complications such as Gastroparesis or delayed gastric (stomach) emptying. The terms are interchangeable.
When food stays in the stomach longer than it should, it becomes known as gastroparesis (stomach paralysis). This condition can occur in anyone, but happens more frequently in patients with diabetes and Type 1 more frequently than Type 2 patients. There is no CURE for this condition,
The stomach, under normal conditions, empties its contents into the small intestine in a controlled manner. When food is ingested, the stomach contracts and crushes the food and then pushes the food from the stomach into the small intestine where it will be further digested. In a person with gastroparesis, the muscle contractions do not function properly so the food isn't crushed and properly pushed into the small intestine in the way it should for digestion to continue. The stomach does not empty fast enough and the food remains in the stomach. Over time symptoms (Table 1) will develop and a diagnosis will be made.
Table 1. Symptoms of gastroparesis
Nausea, vomiting, heartburn
Feeling full after eating a few bites of food
Unintentional weight loss and loss of appetite leading to malnutrition
Stomach bloating/pain
Increased difficulty in managing blood glucose levels (both highs and lows may increase in frequency).Delayed high blood glucose a few hours after eating because of the delayed digestion of the food you ate thereby making it difficult to adjust insulin dose pre meals.
The causes for gastroparesis are not fully understood but there are some possible explanations as you review the literature on the topic. One of the more popular explanations has to do with damage to the vagus nerve which is responsible for controlling the movement of food through the digestive tract. This vagus nerve is an important link from the gut to the brain. It sends messages to the muscles in your stomach telling them when to contract and move food into the small intestine. Thus, if this vagus nerve is impaired, this signal is not sent to the stomach muscles and thus food does not get emptied and remains for long periods in the stomach.
Causes other than diabetes may include:
If you had abdominal or esophageal surgery
If you have suffered an infection due to growth of bacteria in the stomach
If you suffer form Parkinson's disease or multiple sclerosis
If you have low thyroid levels (many patients with diabetes do suffer from thyroid disorders)
If you are female as it is more common in women than in men
Medications that slow the rate of stomach emptying such as narcotic pain medications, allergy medications, antidepressants and maybe even some blood pressure medications. Check with your pharmacist to find out if any of your medications would promote delayed stomach emptying. .
Gastroparesis is diagnosed when you have the symptoms and a test result which shows slower than normal emptying of the stomach into the small intestine when there is no definite blockage (eg. hernia, Crohn's disease or diverticulitis). There are many different types of tests and they all measure how fast the stomach empties which is important for a proper diagnosis. No doubt you will get referred to an gastrointestinal specialist once the diagnosis is made, if not before. As with many tests, having your blood sugar within a good range before the test will get more reliable test results. Discuss this with your doctor well in advance of having the tests. You want to know in advance if any of your medicine needs to be stopped a few days ahead of the tests.
Treatment varies and will depend on the degreee of gastroparesis as interpreted by the health care team. As mentioned above, there is no cure but there are things you can do to help make life better while living with this condition.
Treatment options may include (not all inclusive):
Dietary changes- I suggest you see a dietitian to ensure proper nutrition
Avoid high fiber foods as they take longer to digest
Eat small meals and eat more often
Eat more slowly
If required, eat more liquid foods/meals
Eat the healthy food first rather than those with empty calories
Chew foods well
Limit or avoid greasy foods that can slow stomach emptying
Don't lie down after your eat for at least one hour
Medications may be needed that help improve the movement of food through the stomach and gastrointestinal tract. A medication for nausea and vomiting may also be considered if this is one of your symptoms. Your doctor will discuss this with you at some point and further counselling can be done by your pharmacist.
Insulin dosing change(s)-such as
Taking insulin more often to correlate with the absorptionof the food
Change the type of insulin you use (perhpas to a quicker onset or a slower onset with a longer duration of action)
Timing of insulin- may be asked to take insulin after your meals and this way you know what you were able to eat at any one time
Checking blood sugars more often and especially after eating
Stop smoking-as smoking delays stomach emptying of solids
Not only are there physical symptoms associated with gastroparesis but also psychosocial aspects of this disease have been studied which show that patients do exhibit a lower quality of life. Symptoms such as pain, nausea, vomiting, hypo or hyperglycaemia and inconsistency of symptoms and the necessary life style changes would definitely be difficult. I know they would me for me.
I strongly encourage you to seek medical atention if you are experiencing any of the sign and symptoms of Diabetic Stomach (gastroparesis). The earlier it is diagnosed the sooner treatment can begin either with medication and/or lifestyle changes or both.
The above is intended for information purposes only. It is not meant to replace medical advice you have received from your health care team.
References
Diabetes Canada
Above image from Creative Commons Google images accessed on Mat 21,2022
Image taken from Google images on May 20th,2022 Refer to this site for more information and description of gastroparesis.