What to know about diabetic gastroparesis
In this article, we provide an overview of diabetic gastroparesis, including its causes, symptoms, complications, and treatments.
What is diabetic gastroparesis?
A person with diabetic gastroparesis may experience nausea and heartburn.
During normal digestion, the stomach contracts to help break down food and move it into the small intestine. Gastroparesis disrupts the stomach's contraction, which can interrupt digestion.
Diabetes can cause gastroparesis due to its effects on the nervous system.
When the vagus nerve experiences damage, the muscles in the stomach and other parts of the digestive tract are not able to function properly. When this happens, food cannot move as quickly through the digestive system.
Gastroparesis is also known as delayed gastric emptying.
Signs and symptoms of gastroparesis vary in severity from person to person and may include any combination of the following:
- nausea and vomiting, particularly of undigested food
- feeling full after eating very little
- loss of appetite
- unintentional weight loss
- unstable blood sugar levels
- gastroesophageal reflux
- stomach spasms
Some people with diabetes are at greater risk of developing gastroparesis than people without diabetes.
Risk factors for developing diabetic gastroparesis include:
- having type 1 diabetes
- having type 2 diabetes for longer than 10 years
- having coexisting autoimmune diseases
- having a history of certain gastric surgeries
Gastroparesis is more common in females than males, and in people who have had surgery around the esophagus, stomach, or small intestine, as surgery can affect the vagus nerve.
The unpredictability of gastroparesis makes it difficult for someone with diabetes to know when to take insulin.
Gastroparesis makes it harder for a person with diabetes to manage their blood sugar levels.
Sometimes, the stomach of a person with gastroparesis may take a very long time to empty the food into the intestine for absorption. Other times, the stomach may pass the food very quickly.
This unpredictability makes it difficult for someone with diabetes to know when to take insulin, meaning that their blood sugar levels may get too high or too low at times.
When blood sugar levels are too high it puts a person with diabetes at greater risk of the following:
- kidney damage
- eye damage, such as retinopathy and cataracts
- heart disease
- foot complications that can lead to amputation
When blood sugar levels drop too low, a person with diabetes may experience the following complications:
- diabetic coma from low blood sugar
- loss of consciousness
Other complications from diabetic gastroparesis can include:
- bacterial infections
- indigestible masses, known as bezoars, which can cause stomach obstruction
- electrolyte imbalance
- tears in the esophagus from chronic vomiting
- inflammation of the esophagus that may cause difficulty swallowing
If a doctor suspects a person with diabetes has gastroparesis, they will typically order one or more of the following tests to confirm the diagnosis.
A doctor may start with a barium X-ray to check for gastroparesis. For a barium X-ray, a person will fast for 12 hours, drink a liquid containing barium, and then have an abdominal X-ray. The barium will coat the stomach to make it visible on X-ray.
Usually, a person who has fasted prior to this test has an empty stomach. However, someone with gastroparesis may still have some food in their stomach.
Barium beefsteak test
The barium beefsteak test involves a person eating food that contains barium and then having imaging tests while the meal digests. A doctor will watch the person's stomach via imaging to see how long it takes for food to leave.
Radioisotope gastric-emptying scan
Similar to the barium beefsteak test, the radioisotope gastric-emptying scan involves a person eating food that contains a radioactive compound before they have an imaging test.
A gastric manometry measures the activity of the muscles in the stomach.
During a gastric manometry, a doctor will insert a narrow tube through a person's throat into their stomach. The tube includes a device that measures the stomach's activity as it digests food. The measurements show how well the stomach is functioning.
Additionally, a doctor who suspects diabetic gastroparesis may order any of the following tests:
- Blood tests to check for nutritional deficiencies and electrolyte imbalances that are common with gastroparesis.
- Imaging of the gallbladder, kidneys, and pancreas to rule out gallbladder problems, kidney disease, or pancreatitis as causes.
- An upper endoscopy to check for abnormalities in the structure of the stomach.
Taking certain oral medications can help stimulate the stomach muscles and reduce nausea.
Managing blood sugar levels is the most important part of treating diabetic gastroparesis.
Most doctors will advise a person with diabetic gastroparesis to check their blood sugar levels more frequently than someone with diabetes who does not have gastroparesis. More frequent blood sugar checks can help the individual and their doctor better tailor their treatment.
Treatment can include any combination of the following:
- changing the dosage and timing of insulin
- oral medications for gastroparesis, including drugs that stimulate the stomach muscles and medications for nausea
- avoiding drugs that may delay gastric emptying, such as opiates
- changes in diet and eating habits
In some cases, a person with diabetic gastroparesis may need a feeding tube or intravenous nutrition. Doctors only recommend this if the person cannot manage their blood sugar or the gastroparesis is very severe.
When a feeding tube is needed, it will bypass the stomach completely, putting nutrients directly into the intestine. This helps keep blood sugar levels stable. In many instances, feeding tubes are temporary.
Many doctors will recommend a person with diabetic gastroparesis make certain dietary changes, including:
- eating frequent, smaller meals instead of three larger meals each day
- limiting high-fiber foods, such as broccoli, which take longer to digest
- sticking to mainly low-fat food
- eating well-cooked vegetables instead of raw vegetables
- avoiding alcohol and carbonated drinks
A doctor or nutritionist may recommend a person with diabetic gastroparesis eats certain foods, including:
- lean meats, such as lean cuts of beef or pork
- skinless poultry with a low-fat preparation method (not fried)
- low-fat fish
- tomato sauce
- cooked carrots and mushrooms
- skinless sweet potatoes
- applesauce with no added sugar
- low-fat milk or yogurt
Also, a doctor or nutritionist will likely recommend that a person with diabetic gastroparesis make some changes around meal times, such as taking a walk after eating to promote digestion. Likewise, many doctors may suggest waiting at least two hours after eating to lay down.
A comprehensive review in the journal Diabetes Therapy on diabetic gastroparesis suggests that people with this condition have more hospitalizations, emergency room visits, and other complications from diabetes than people with diabetes who do not have gastroparesis.
People with diabetic gastroparesis are also more likely to experience eye damage, kidney damage, and heart disease than those with diabetes alone. This increased risk of complications may raise a person's risk of early death due to diabetes-related causes.
The likelihood of complications and overall outlook for a person with diabetic gastroparesis will vary between individuals. In general, people can improve their outlook by learning how to best manage their blood sugar levels each day.