Diabetes Gastroparesis

Gastroparesis can Be a Cause & Effect of Diabetes

​Diabetes, in general, has the taunting ability to disrupt the quality of life of the affected individual. Inappropriate blood glucose levels result in diabetes and these bring additional consequences to health. In due course, diabetes starts affecting various other parts of the body including the heart, kidneys, nerves, foot, and even skin. Besides these, there are also very high chances for gastrointestinal complications including gastroparesis, non-alcoholic fatty liver disease, and intestinal enteropathy (which manifests with side effects including constipation, fecal incontinence, and diarrhoea).
 
What is Gastroparesis?
 
Gastroparesis is a condition which has a debilitating impact on the way food is digested and diabetes exists as the most common cause of this problem. Almost 5-12% of the diabetic population exhibits symptoms that favor the existence of the disease. In people with gastroparesis, muscles in the stomach wall fail to do their function properly or stop functioning altogether thereby putting off or slowing down the rate at which the food consumed moves from the stomach to the intestine. Popularly known as ‘delayed gastric emptying,’ this complication arises only because of the ineffective functioning of the muscle but not because of any blockage obstructing the movement of food.
 
As the condition impacts the food absorption, there are problems with insulin doses against food quantities. There are also higher risks for malnutrition as nutrients might not be absorbed as desired, but this is a worrisome issue only if we leave it untreated. Generally, gastroparesis affects people with type 1 diabetes but individuals with type 2 diabetes can also become victims sometimes. In most cases, this becomes a problem in those suffering from diabetes for more than 10 years or so.
 
Link between the Disease & Diabetes
 
Gastroparesis and diabetes have a direct link between each other. Variations in blood glucose levels deter stomach emptying and the reverse is also true. There are various studies showing that increase in blood glucose levels increase the risk of gastroparesis. At the same time, we also have research data supporting the fact that individuals suffering from the condition find it very tough to manage blood glucose levels.
 
But before concluding anything, it is always advisable that the physician enquires about different symptoms of the problem which are given below. Surprisingly, though almost 50% of diabetics have this problem, most of them don’t have any of the digestive symptoms. There are some patients who are diagnosed with the condition even in the absence of any symptoms as they remain unable to manage blood glucose levels even after sincere efforts. In such cases, the physician might consider stomach emptying as a reason for such problems with diabetes management.
 
Symptoms
 
Some of the common symptoms of the disease include:
 

• Throwing up regularly, even everyday in some cases when the condition becomes severe and because of this, risk of malnutrition goes up multifold times
• Nausea
• Abdominal Bloating and pain
• Loss of appetite combined with weight loss
• Fullness (early satiety) even when eating very small portions
• Heartburn or reflux
• Bad control of blood glucose levels
• Lack of ability to finish a meal completely

 
Diagnosis
 
Though symptoms help in finding the presence of some disease, these alone aren’t sufficient to come to any conclusions. Physicians might do a physical examination, ask you to do a blood sugar test, and also prescribe for some other tests such as:
 
Barium beefsteak meal: As the name suggests, the patient is given a meal with barium and with the help of an X-ray, the time taken to digest the food is calculated. With this, the time taken for stomach emptying is also calculated.
 
Gastric manometry: A thin tube is inserted from the mouth into the stomach to measure how fast food can be digested.
 
Electrogastrography: Electrodes in the skin are placed to measure the electrical activity in the stomach.
 
Barium X-ray: Liquid barium is given for drinking and this forms a coating on the esophagus, stomach, and small intestine which is clearly visible in an X-ray.
 
Radioisotope gastric-emptying scan: After consuming food with some radioactive substance, the patient is made to lie under a scanner. Presence of more than 50% of the meal in the stomach even after 1.5 hours is a clear indication of gastroparesis.
 
Other tests that help diagnosing the disease include performing an upper endoscopy, biopsy of the small intestine/stomach, ultrasound, and wireless motility capsule to analyse the rate of stomach emptying—slowly, normally, or rapidly—and to confirm that there is nothing blocking the movement of food.
 
Treatment
 
The most predominant treatment approach for handling gastroparesis includes making diet-related changes, achieving glycemic control, and monitoring fluid intake. Diet changes includes limiting fat consumption to not more than 25-30% of the total calories consumed, keeping fiber intake to well under 15 grams for 1,000 calories of food taken, and eating small meals frequently. It’s better to get the help of a nutritionist/dietitian to plan a well-balanced meal plan as spicy, fatty, and acidic foods must be avoided, and choosing foods can be a challenging task. The dietitian might also recommend  patients to avoid consuming legumes, beans, and whole grains as these are rich in fiber.
 
Sometimes, supplements might be necessary to manage malnutrition and correct vitamin and other nutrient deficiencies.
 
Drink plenty of fluids, restrict alcohol consumption, don’t drink carbonated beverages, and avoid smoking altogether. Engage in physical activity for at least 150 minutes daily. Moreover, getting a good glycemic control is mandatory but remains a challenging task as absorption of food is not constant affecting insulin secretion and administration quantities. The healthcare professional might make changes to insulin dosages and medications taken.
 
Conclusion
 
Symptoms of nausea, vomiting, and inability to eat meals might affect the peace of mind of patients and induce stress. There are even times when doctors prescribe medications to control vomiting and nausea, but this happens in extreme situations. As the patients consume less quantities of food, there are higher chances of malnutrition which affects the quality of life of the individual. Gastroparesis is one of the biggest complications of diabetes that might have co-morbidities and increase mortality rates. Though nutritional changes should provide relief, in the case of some individuals, the need for medications and surgical therapy becomes indispensable.