Gastroparesis: A Complication of Diabetes

Written by Rosemary Black
Reviewed by Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE

"Gastro" means stomach and "paresis" means impairment or paralysis. If you have diabetes and are experiencing a variety of unpleasant but non-specific digestive symptoms, gastroparesis may be the culprit.

Upper abdominal bloating, distention, discomfort, nausea, and vomiting are all symptoms of this disorder. Gastroparesis can occur when the vagus nerve, which controls the movement of food through the digestive tract, stops working or becomes damaged; the movement of food is thus slowed or stopped.

If you have this problem, the ability of your stomach to grind up food is reduced or lost entirely. Your system doesn’t break up food into smaller pieces, and food stays in the stomach longer than normal instead of moving on to the intestines and the bowel as it should. In diabetes, high blood sugar can contribute to the development of gastroparesis because over a long period of time, if blood sugar levels stay high, diabetes damages the vagus nerve. 1

Quick Stomach Anatomy Lesson

The stomach is a neuromuscular organ that receives the food we ingest, mixes the food with acid and pepsin, and empties the nutrients into the small intestine for absorption.

The stomach or fundus relaxes in order to receive the swallowed food (that's called receptive relaxation). The body and antrum then mix and empty the food using gastric peristalic waves. The peristaltic contractions are paced by electrical events called pacesetter potentials or slow waves. 

The motility of your GI tract is controlled by an outer sleeve of muscles that surrounds the GI tract. They are controlled by a complex nervous system. Diabetes can damage these nerves, and it is this neurological long-term complication of diabetes that can lead to gastrointestinal disorders.

Gastroparesis isn't common in people with diabetes. It’s estimated that out of 100,000 people, about 10 men and 40 women have gastroparesis. Additionally, gastroparesis symptoms plague about 1 in 4 people, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

It's possible to have these symptoms and not have gastroparesis. “You may experience heartburn, nausea, vomiting, early fullness after a meal, abdominal bloating, lack of appetite or reflux,” says Amy Hess Fischl, MS, RDN, LDN, BC-ADM, CDE, a dietitian and certified diabetes educator.

How Diabetes Impacts the GI Tract 

It’s unclear whether gastroparesis is more common in type 1 diabetes or type 2 diabetes, she says, since the statistics are not readily available or up-to-date. Neuropathy, or nerve damage, is a complication that can occur over the course of years in individuals with both type of diabetes.

It can cause painful hands and feet, among other symptoms. Even individuals who have not been living with diabetes for a long time may develop gastroparesis, which is a type of neuropathy. Individuals with high blood sugars and hemoglobin A1Cs are the ones most likely to develop the long-term complications of diabetes, Hess-Fischl says. “So if someone has other types of neuropathy, it may be possible that they have gastroparesis, too,” she explains.

Diagnosis and Treatment

To diagnose gastroparesis, upper gastrointestinal x-rays and a gastroscopy, in which the physician examines the stomach with a scope containing a tiny camera, may be ordered.  The physician will want to rule out other disorders like ulcers and gastritis.

In terms of treatment, medications are still used to help with the digestion, Hess-Fischl says. “We have to work closely with the individual to adjust their insulin doses, if they are taking meal-time insulin, to match with when their food may be digesting,” she says. “That means they may be taking their doses well after the meal instead of before, as is currently recommended.”

One gastroparesis medication of choice is metoclopramide (Reglan), which acts on the nervous system to increase the strength and frequency of gastrointestinal muscle contractions. It is taken 20 to 30 minutes before meals and at bedtime.

Unfortunately, about 20% of those taking the medication develop annoying side-effects of drowsiness, lethargy, and depression and/or anxiety. It should not be used by people with Parkinson's disease.Talk with a specialist to identify what medication may be right for you if one is needed at all, Hess-Fischl suggests.

When Meds Don't Work

If medications don’t work, you may need surgery to have food bypass your stomach.
The most popular option is a jejunostomy tube. A small feed tube is placed through the skin into the bowel. When a person with gastroparesis is having a bad spell of nausea and vomiting which makes eating or drinking impossible, liquid nitration, fluids, and medication can be delivered through the feeding tube.

A less desirable alternative is to bypass the GI tract all together and place a semi-permanent intravenous line for feeding directly into the bloodstream. Depending on symptoms these alternate feeding methods can be used as a back-up during periods when the person cannot eat, or as a more regular means of nutritional support.

If you have diabetes and you develop gastroparesis, getting your blood sugar into the normal range is highly recommended, Hess-Fischl says. “Maintaining blood sugars within the recommended range, which is under 130 mg/dL before the meal and no higher than 180 mg/dL after the meal and reducing A1C levels to less than 7%, can help to reduce complications,” she explains. Hypoglycemia may result because of the gastroparesis—food is absorbed at unpredictable times, and this makes controlling your blood sugar difficult.

Dietary Changes Can Help 

If you have gastroparesis, there are other steps you can take. Fiber can be difficult to digest since it slows digestion, so you may be told to limit certain high-fiber foods, Hess-Fischl says.

You also may be told to cut down on foods that are high in fat, since fat slows down digestion, to eat smaller meals, to drink fluids between meals, and to remain sitting up for several hours after eating.

Using a continuous glucose monitor (CGM) may also be advised. “Sometimes wearing a professional version temporarily—usually from 7 to 14 days—can help in creating a plan that will work," says Hess-Fischl.”

If diarrhea is a symptom, it’s possible that you are experiencing dehydration and deficiencies in vitamins and minerals. “Your health care provider may recommend a multi-vitamin—a chewable or liquid version may be better tolerated,” she says. “You may also need medications that reduce the diarrhea, too.”

And, if you are diagnosed with gastroparesis, consulting with a registered dietitian nutritionist who specializes in GI disorders is imperative, Hess-Fischl says, so that an individual plan may be put into place to help with your symptoms.

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What Is a Continuous Glucose Monitor (CGM)?