Does Diabetes Cause Gastroparesis?

Diabetes is a chronic metabolic disease that can affect just about any organ. It damages small and large blood vessels, nerves, and changes the functioning of various organs, including those in the gastrointestinal tract.

Diabetes adversely affects the functioning of the complete digestive tract, thus affecting oral health and causing esophageal complications, gastroparesis, enteropathies, and even increases the risk of various diseases of the large intestine.

More than half of those living with diabetes have delayed gastric emptying characterized by bloating and the feeling of discomfort in the stomach. In a few cases, motility of the stomach becomes increasingly slow, leading to an impairment of gastric emptying. A significant slowdown in gastric emptying is called gastroparesis. It is generally slow and gradual in onset, thus it often goes unnoticed for a long period of time. In many cases, gastroparesis is only diagnosed when a person starts suffering from severe gastric pain and uncontrolled vomiting, which would not be suppressed by most drugs.

Why does this motility-related gastric disorder occur? 

One of the most common issues in diabetes is the damage to the nerves; it is something that starts happening from the very early stages of diabetes, though it often goes unrecognized in a large number of cases. As diabetes progresses, around one-third of those living with diabetes would feel the changes in sensation in limbs and numbness.

Although, many are able to recognize the sensory changes in limbs, especially in their hands and feet (also called gloves and socks syndrome), most people do not understand that diabetes also causes so-called autonomic neuropathy. In diabetes, various nerves that control the activities of internal organs are damaged. So, a person living with diabetes have altered gastrointestinal motility, bladder function, and even a changed pulse and libido. Gastroparesis in diabetes is the result of damage to this autonomous nervous system.

In the case of the stomach and gastrointestinal tract, many functions are controlled by a nerve called the vagal nerve. In diabetes, conduction and the functioning of the vagal nerve is altered, resulting in a slowdown of motility of the gastrointestinal tract in general, and stomach particularly.

Once the emptying of the stomach becomes slow in digesting, the person often starts feeling full even after having a small amount of food. A person may feel nauseated and have reflux, bloating, abdominal discomfort or pain, and weight loss.

Alteration of gastrointestinal motility creates several challenges for a person living with diabetes, not just problems of malnutrition. It becomes challenging to control the blood sugar levels. If food stays in the gastrointestinal tract for too long, it may increase blood glucose, while if a person eats too little, there is a risk of hypoglycemia. Further, it becomes tough to take oral medications as they may become less efficient or may not work as intended.

In severe cases, control of blood sugar may become quite erratic, thus further worsening the condition. In some cases, there may be continuous vomiting causing severe dehydration and leading to hospitalization. Gastroparesis increases the risk of life-threatening conditions like the obstruction of the gastrointestinal tract due to the hardening of food in the stomach.

Although gastroparesis is more common in type 1 diabetes, however, it is also frequent in type 2 diabetes. Gastroparesis in type 2 diabetes is clinically important as more than 90% of cases of diabetes are living with type 2. Further, type 2 is often treated with oral drugs in the initial phases and not with the injections as is the case of type 1 diabetes. So, for treatment to be effective, it is essential that gastrointestinal motility and functionality remains regular and predictable.

In type 1 diabetes also gastroparesis creates specific problems. In type 1 diabetes injectable insulin is the primary treatment. But, if there is gastroparesis and a person takes insulin with food, there is a risk of developing severe hypoglycemic shock since the food would not move forward and nutrients would not get absorbed.

Moreover, it must be understood that diabetes is not the only condition that can cause gastroparesis, it may happen due to many other conditions, and many of them may even coexist with diabetes. Gastroparesis may also occur in neurodegenerative disorders like multiple sclerosis or Parkinson’s. Though gastroparesis is rarely a fatal complication, it can significantly affect the quality of life, increasing healthcare costs, the frequency of visits to emergency wards and so on.

Diabetes can be managed but not cured, and many of its complications occur due to the irreversible damage to nerves, blood vessels,and other cellular structures. The issue with gastroparesis in diabetes is that it is tough to treat, as a slow down of gastric movement is due to severe damage to the nerves. It is not something that could be reversed in most cases. It means that once the condition is diagnosed, it keeps reoccurring, resulting in significant illness.

If you think that you are suffering from gastroparesis or just a sluggish stomach, it's best to consult your physician. Your doctor may send you to a gastroenterologist for further investigations. Diagnoses of gastroparesis is not always possible to reach based on physical signs, more so in milder cases. To confirm the diagnosis, the specialist would carry out various studies regarding gastric movement, gastric emptying, and so on. Additionally, the doctor may also recommend an endoscopy and ultrasound to rule out other problems.

Gastroparesis is challenging to treat, as there is only a limited number of drugs that may help in improving the gastric motility. For overcoming the issues caused by gastroparesis, dietary changes are essential. The advice of a qualified dietitian with experience in treating gastroparesis may help. Usually, a dietitian would recommend eating more often, but in smaller portions. There is also a need to cut down on fatty food and food high in fibers as these kinds of food items are slow to digest. A person may need to eat more of soft food items, like soups and pureed foods. With little trial and error, you may be able to find out which food items to eat more often and which one to avoid, just by listening to one’s stomach.

In gastroparesis, you would have to increase the fluid intake, intake of micronutrients, supplementing micronutrients like vitamins and minerals could be an option too. Diagnosis of gastroparesis has to be taken seriously, or else it may lead to a surgery where the surgeon creates a hole in the stomach for feeding through a tube in order to entirely bypass the stomach.

However, there is no need to be frightened or discouraged if you feel that you have the sluggish stomach. Several medications can also be used to help to accelerate the motility. In fact, one of the most common antibiotics called erythromycin has been shown to be quite useful in improving gastric motility. Other specific drugs for gastric motility like metoclopramide may also help.

In case of slow gastric emptying, there is also a need to make changes to diabetes treatment. The doctor may adjust the doses of some of the drugs or may bring a person on insulin. You also have to change the way of taking insulin, thus in gastroparesis, insulin is taken after the meals instead of before meals. There is also a need to check blood glucose levels more often.

Gastroparesis is a severe and mostly irreversible complication of diabetes that has limited treatment options. So, the best way is prevention through adequate blood glucose control. People who manage their diabetes well are at much lower risk of ever developing gastroparesis.

References

1. Shakil A, Church RJ, Rao SS. Gastrointestinal Complications of Diabetes. AFP. 2008;77(12):1697-1704.
2. Krishnan B, Babu S, Walker J, Walker AB, Pappachan JM. Gastrointestinal complications of diabetes mellitus. World J Diabetes. 2013;4(3):51-63. doi:10.4239/wjd.v4.i3.51
3. American Diabetes Association. Gastroparesis. American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/gastroparesis.html. Published October 16, 2017. Accessed February 16, 2018.
4. Bernstein G. The Diabetic Stomach: Management Strategies for Clinicians and Patients. Diabetes Spectrum. 2000;13(2000):11.