What is diabetic gastroparesis?
Gastroparesis is a problem with the stomach not working properly. It is also called delayed gastric emptying. With gastroparesis, food in the stomach empties slowly into the small intestine. This can cause symptoms such as nausea, vomiting, fullness after meals, bloating (usually above the bellybutton), and pain. Gastroparesis may be due to problems with the stomach muscles or the nerves that control those muscles. It may also be due to problems with the special cells within the stomach muscles that control its movement.
Gastroparesis can happen in anyone. It is common in people with diabetes. Roughly one-third of people with type 1 or type 2 diabetes may develop gastroparesis. When diabetes is the main cause of gastroparesis, it is called diabetic gastroparesis. Like diabetes, gastroparesis is a chronic, or lifelong, condition. And being told that you have another chronic condition can be overwhelming. But, there are things that you can do to manage your condition and lead a healthy, active life. Read on to learn more.
Signs and symptoms
Signs and symptoms are different for each person. Some people may not have symptoms while others do. Symptoms can come and go. Over time, they can change in how severe they are and how often they take place. Common symptoms include nausea and vomiting (throwing up). Often, vomiting may involve whole pieces of food that have not been broken down in the stomach. Some patients can even identify food that they have eaten several hours (4 or more) before. Pain in the upper part of the belly (abdomen) is another symptom. People with gastroparesis also say that they feel full even after eating a small amount of food. They may have to cut back on the amount of food they eat to lessen their symptoms.
Other symptoms may include:
- Heartburn (a burning feeling in the chest or throat).
- Loss of weight (without trying).
- Bloating (swelling).
- Not feeling hungry.
Different treatments are available. These center on easing symptoms, such as nausea and vomiting. Medicines, diet, and lifestyle changes are often used. Talk with your health care provider about what treatments are available and which ones would be best for you.
Understanding normal gastric emptying
Generally when food and fluid move into the stomach
- Muscles in the stomach wall mix the food and liquid and churn it into smaller pieces.
- Glands in the stomach add other fluids, like acids and enzymes, to help break down the food and fluid.
- Together, they make a substance called chyme.
- Muscles of the stomach contract in a wavelike motion called peristalsis.
- Pressure in the stomach increases to cause the breakdown of food. Then the sphincter (muscle ring at the end of the stomach) opens to allow the small particles of food through.
- Chyme moves out of the stomach into the duodenum (the first part of your small intestine).
Nerves from the brain and spinal cord control the action of the stomach muscles. The stomach muscle itself also has special cells, called the interstitial cells of Cajal (ICC). These cells are called pacemaker cells. They send the signals that make the stomach muscles start to tighten. This helps move chyme out of the stomach.
Gastroparesis and Diabetes
Muscles, including those of your stomach, need healthy nerves to trigger and control movement. But, over time, high blood glucose (a type of sugar that your body uses for fuel) from diabetes can harm the nerves. The signals needed for the body to work the right way don’t get sent out. Diabetes can also injure the blood vessels. As a result, the nerves don’t get the oxygen and nutrients they need.
When diabetes causes injury to the nerves, the stomach muscles don’t make the strong wavelike movements that carry chyme to the duodenum. The muscle contractions are slower, less powerful, or less frequent. Some of the chyme stays in the stomach and the stomach doesn’t empty fully. Stomach emptying also slows when you eat foods that are high in fat and fiber.
Causes of gastroparesis
In most cases, the cause of gastroparesis is not known. This is called idiopathic gastroparesis. In up to a third or slightly more cases, the cause is diabetes. High levels of blood glucose from diabetes can injure the stomach muscle, the nerves, or ICC. In fact, diabetes is the most frequently identified disease linked to gastroparesis.
Hyperglycemia (high blood glucose levels) affects the muscles of the stomach.
- The muscles in the upper part of the stomach become more relaxed.
- The muscles in the middle and lower parts of the stomach aren’t able to shorten as often or with the usual amount of force.
- The signals from the nerves to the stomach muscles are altered so that the wavelike action occurs unevenly.
- All these events slow the emptying of your stomach.
Delayed gastric emptying can also affect blood glucose levels and control of diabetes. How fast or slow the stomach empties can change how the body absorbs the carbohydrates and fats (the main nutrients that provide the body with energy) that are eaten.
Diabetic gastroparesis is a chronic condition. There is no cure, but the condition can be managed. With medicines, changes to the diet, and other forms of treatment, you can learn to take charge and control it. That way, you’ll be able to do more things that matter to you. You can feel and live better, with fewer symptoms.
Remember, you’re not alone. Your health care team is there to support you. Work closely with them on a treatment plan that meets your needs. Talk with your health care provider about goals and challenges. Speak up if you have concerns. Also, be sure to get answers to any questions you have. Know that even small changes can result in big improvements in your health over time.
Procedures for diagnosing diabetic gastroparesis
A health care provider may want some procedures done to confirm diabetic gastroparesis. These help rule out the chance that the symptoms are due to a block or structural problem. Talk with your health care provider about how to get ready for the procedures, including taking medicines and not eating or drinking before the procedures.
Treating diabetic gastroparesis
Being diagnosed with a chronic condition, such as diabetes, can be lifechanging. And finding out that you have another chronic illness due to diabetes can be even more upsetting. It’s okay to feel sad, guilty, or even afraid. These feelings are natural and understandable. Give yourself time to adjust to the news and to the changes that the diagnosis brings. Know your feelings will likely improve with time and as you learn more about caring for yourself. Talk with your health care team about how you’re feeling. They can help you feel less overwhelmed and more ready to plan for a healthy future.
Learning how to manage your chronic conditions takes work. And it doesn’t happen overnight. Take it one step at a time. With practice, managing your diabetic gastroparesis can become part of your life. You’ll gain confidence as you take charge of your life and your health.
Use these tips to help you make the most of your diabetes management plan.
- Understand the medicines you are taking. Take them exactly as directed. When you have diabetic gastroparesis, your health care provider may change your medicine or dose or have you take it at a different time.
- Know what your target blood glucose level is. Understand what to do if your numbers are outside your target range.
- Check your blood glucose levels as often as your health care provider recommends. Keep a record of your readings. Call your healthcare provider if your readings are staying above your target range.
- Watch for signs and symptoms of high blood glucose, such as being thirsty, urinating more, or feeling more tired. Know what to do if your blood glucose is high.
- Follow your meal plan. Be aware of what foods cause your blood glucose to go up. If your health care provider advises you to increase the amount of fruits and vegetables in your diet, remember that those high in fiber may empty from the stomach more slowly. Cooking them and then passing them through a blender can help move these foods along better once they are eaten.
- Be as physically active as you can. Being active can help keep your blood glucose under control. And it may help speed up gastric emptying. Pick activities that you enjoy. You’ll be more likely to make the activity a habit.
- Have a sick-day plan and follow it. Remember, blood glucose can rise quickly when you are sick.
Making the best food choices
When you have diabetes, eating food from all the food groups gives your body the nutrients it needs and keeps your blood glucose levels in their target range. With diabetic gastroparesis, you’ll likely feel better if you also limit or avoid foods that are high in fat and fi ber. But what to choose? The list below gives you some examples.
Tips for eating
- Fiber and fat can slow the emptying of your stomach. Fiber can also clump together and cause a blockage. So, it’s best to stay away from or limit foods that are high in fat and fi ber. When eating fruits and vegetables, remember to cook them thoroughly and pass them through a blender.
- Solid food in the stomach is harder to break down. Be sure to chew your food well before swallowing it. Try braising, poaching, simmering, and stewing for cooking. These methods make food tender and easier to chew. Blenderizing foods to be like a thick soup can also help.
- Smaller meals can help lessen bloating. Plus, eating less food may make it easier for the stomach to empty because it is not as full. Try eating 5 to 6 small meals a day instead of 3 large ones.
- Sitting up when eating also helps lessen the pressure in the stomach and makes it easier for the stomach to empty. Avoid lying down after eating.
- Alcohol and smoking can slow gastric emptying. Avoid them.
- Carbonated drinks can give off carbon dioxide (gas) and make you feel bloated. Try to limit or avoid them.
- Drinking large amounts of fluid at one time with a meal can add to bloating. Taking small amounts or sips of fluid throughout your meal can help the stomach empty.
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©American Gastroenterological Association; Gastroparesis Booklet