Diabetes Complications: Diabetic Gastroparesis

Diabetic gastroparesis is a complication of diabetes with no known cure, and it is an important one to watch out for. Gaining an awareness of how to prevent and manage the condition can go a long way in maintaining the health and well-being of diabetic patients.

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Diabetes Complications: Diabetic Gastroparesis

There are many complications associated with diabetes.  One lesser known but serious complication is gastroparesis.  Gastroparesis is a gastrointestinal (GI) disorder whose cause is often unknown but most commonly affects people with diabetes. This disorder slows down gastric emptying causing a range of symptoms that may compromise health and well-being.  Gastroparesis is difficult to treat, but there are treatment options available that can improve health outcomes and quality of life for those who suffer from the condition.  In addition, there are ongoing studies investigating new ways to diagnose and manage this disorder.

What is Gastroparesis?

Gastroparesis is a disorder in which the stomach empties its contents at a much slower rate than normal.  This is referred to as delayed gastric emptying.  Delayed emptying of stomach contents can cause persistent abdominal discomfort, bloating and nausea or may even lead to vomiting. 

The stomach cannot tolerate regular amounts of food because it is continuously full.  Often, people affected by gastroparesis fail to get adequate nutrition because the constant feeling of fullness and/or nausea that they experience prevents them from eating enough food to meet their bodies' needs.  

What Causes Diabetic Gastroparesis?

Sometimes the vagus nerve, which aids in digestion by stimulating muscle contractions in the stomach, is damaged in diabetic patients.  Fluctuating blood sugar levels can damage this nerve over time. 

Another factor that leads to gastroparesis is the destruction of pacemaker cells in the stomach.   Pacemaker cells are responsible for the wavelike motions of the stomach wall (peristalsis) that move food through to the small intestine.  In diabetics with gastroparesis, high levels of free radicals attack the pacemaker cells.   Normally, free radicals are kept in check by a specific stomach enzyme.  This radical busting enzyme is found in abnormally low levels in some diabetics. 

Damage to the nerves and cells that are vital to the digestive process causes food to remain in the stomach leading to the various symptoms associated with this disorder.

Symptoms

Symptoms of diabetic gastroparesis may include the following:

  • Abdominal bloating and discomfort
  • Difficulty controlling blood sugar levels
  • Early satiety
  • Nausea
  • Vomiting
  • Weight loss

Diabetic gastroparesis can take a serious toll on those who suffer from the disorder.  This condition not only affects health outcomes, but also quality of life.  It is not unusual for this population to experience both physical and psychological complications.

Complications

Some people may experience the following complications as a result of diabetic gastroparesis:

  • Anxiety and depression
  • Dehydration
  • Diminished quality of life
  • Irregular absorption of medications
  • Malnutrition
  • Unstable blood sugars

Diagnosis

Healthcare providers will evaluate the symptoms their patients present with and order tests to help diagnose the condition.  Some of these tests, like scintigraphy, use imaging to determine the speed of gastric emptying.  Other diagnostic tests, such as endoscopy and ultrasound, may be used to rule out other conditions that can cause similar symptoms to those associated with gastroparesis.  Once a provider has made a diagnosis, they can collaborate with their patient to come up with a treatment plan. 

Treatment

Diabetic gastroparesis is a chronic condition that can be treated but not cured.  It can be managed with changes to diet, certain prescription medications and, if needed, medical procedures.  Since a key treatment for this condition is dietary management, healthcare providers may recommend meeting with a registered dietitian. 

Dietary Recommendations

Important dietary recommendations include:

  • Eating 6 small meals per day
  • Consuming liquids and soft foods
  • Avoiding high fiber and high fat foods

Medications

The following types of medications may be prescribed:

  • Antiemetics (medications that combat nausea and vomiting)
  • Prokinetics (medications that stimulate gastric motility)

Medical Procedures

Medical procedures may be indicated for more severe cases of diabetic gastroparesis where dehydration and malnutrition are present.  This type of treatment may involve:

  • Enteral feeding (nutrition administered through a tube inserted in the nose or abdominal wall)
  • Parenteral feeding (intravenous therapy in which nutrition is administered directly through a vein)
  • Gastric neurostimulation (an implanted device that delivers electrical stimulation to the stomach muscles)

Whether a person has type 1 or type 2 diabetes, they are at risk for developing gastroparesis. 

FACT: One of the best things a diabetic can do to prevent this type of complication is maintain optimal control of blood sugar levels.

Thorough education on how to best control blood sugar levels can be provided to the diabetic patient by their healthcare provider. 

If a diabetic is diagnosed with gastroparesis, their provider will come up with a comprehensive treatment plan that includes optimization of both physical and emotional health.  Improved management of diabetic gastroparesis is also on the horizon as studies and clinical trials, aimed at identifying new treatment modalities, are currently underway.

References

Gastroparesis

Gastroparesis: Symptoms/Causes

Diabetic Gastroparesis

Physiology, Gastrointestinal Nervous Control

Diabetic gastroparesis

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Kate Delaney Chen

About Kate Delaney Chen, BSN, RN

Kate Delaney Chen is a registered nurse and healthcare writer with over 15 years of clinical experience. Her specialties include nephrology, addictions, pain management and health informatics.

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Nice article!

 

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Specializes in Nephrology and Psychiatric Nursing.

Thanks!  I wanted to do an informative piece on this.  It was many years before I encountered my first patient with this condition, and I didn't know much about it at the time.  I see it more frequently now on my med-surg unit, and it's pretty devastating for my patients.  I would love to see new treatments for this!

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