Gastroparesis: a complication of diabetes

Gastroparesis means that the stomach muscles do not contract properly, causing fluid and food to linger far longer than normal. Gastroparesis can be an extremely troubling complication of both type 1 and 2 diabetes. It is due mainly to damage to the nerves that control flow of food from the stomach into the intestine. Elevated blood glucose levels can also contribute to the problem.

There are several approaches to try to reduce the sense of fullness, nausea, and inability to eat, but they rarely bring complete relief. Recommended dietary changes include limiting fatty foods, because they delay the stomach from emptying, and limiting fresh fruits and vegetables, because fiber is difficult for the stomach to evacuate. Meals should be small and frequent. If solid foods are especially hard to tolerate, put them through the blender and swallow them in liquid form. Rarely, doctors may place a feeding tube directly into the small intestine to bypass the stomach.

Every effort should be made to maximize glucose control in patients with type diabetes in order to minimize the risk of developing complications such as gastroparesis.  However, good glucose control can be very challenging. The variability of food absorption due to the gastroparesis makes it difficult to predict the best dosing schedule for insulin.

A variety of drugs, called "prokinetic" or "promotility" agents, have been tried in patients with gastroparesis. At best, they provide partial improvement. Erythromycin, an antibiotic, also has promotility properties. It is most likely to be helpful when delivered intravenously before eating, obviously a fairly difficult thing to do at home. Oral erythromycin works only occasionally.

Other drugs that are sometimes used include metoclopramide and cisapride. Metoclopramide can have troublesome side effects, including abnormal muscles contractions in the face or body, anxiety and depression. Cisapride has been restricted for use only by physicians authorized to prescribe it because of its potential to cause dangerous heart rhythm problems. Another drug, domperidone, is unavailable in the United States but can be obtained in Canada.

Several novel approaches to gastroparesis are in the early stages of testing. One is the injection of Botox (via an upper endoscopy) into the muscular valve (called the pylorus) that controls emptying of the stomach into the first part of the intestine. The hypothesis is that by relaxing the muscles of the valve, Botox might promote better gastric emptying. Another approach being studied is the implantation of electrodes into the stomach to allow electric stimulation to restore normal contractions. It is much too early to know whether either of these should achieve broad use.

What complications of diabetes have you experienced? What have you done to help improve their symptoms?

Nearly 21 million Americans suffer from diabetes, and as anyone who has been affected by the disorder knows, it is about much more than a statistic: it means a new way of life. Diabetes: A plan for living is a special report from Harvard Medical School that will help you learn how to better understand and manage your diabetes, including type 1 and type 2, as well as other variations of the disease. This report will show you that it’s not just possible to live with diabetes; it’s possible to live well.

Are you Living With Diabetes? Connect with others with similar health concerns and issues. Click here to join the group.