Digestive problems are relatively common among people with diabetes. The most common is constipation, affecting nearly 60% of people with diabetes. Diarrhea and other gastrointestinal symptoms may also occur. For instance, diabetes is the most common causes of gastroparesis (delayed emptying of the stomach).
Gastroparesis is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.
Gastroparesis may occur in people with type 1 diabetes or type 2 diabetes. High blood glucose levels associated with diabetes cause chemical changes in nerves and damage the blood vessels that carry oxygen and nutrients to the nerves. Over time, this process damages the vagus nerve.
Signs and symptoms of gastroparesis are
- pain in the upper abdomen
- vomiting of undigested food—sometimes several hours after a meal
- early feeling of fullness after only a few bites of food
- weight loss due to poor absorption of nutrients or low calorie intake
- abdominal bloating
- high and low blood glucose levels
- lack of appetite
- gastroesophageal reflux
- spasms in the stomach area
Eating solid foods, high-fiber foods such as raw fruits and vegetables, fatty foods, or drinks high in fat or carbonation may contribute to these symptoms.
The symptoms of gastroparesis may be mild or severe, depending on the person. Symptoms can happen frequently in some people and less often in others. Many people with gastroparesis experience a wide range of symptoms, and sometimes the disorder is difficult for the physician to diagnose.
Gastroparesis can make diabetes worse by making blood glucose control more difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person’s blood glucose levels can be erratic and difficult to control.
To control blood glucose, you may need to
- take insulin more often or change the type of insulin you take
- take your insulin after you eat instead of before
- check your blood glucose levels frequently after you eat and administer insulin whenever necessary
Your doctor will give you specific instructions for taking insulin based on your particular needs.
Symptoms may be mild or severe, depending on the individual, but gastroparesis tends to be a chronic condition. The main treatment for gastroparesis in people with diabetes is to regain control of blood glucose levels. Treatment may include insulin, oral medications, changing your meal plan and, in severe cases, a feeding tube and parenteral nutrition.
Changes in eating habits may help control symptoms. For example, it may be easier to eat six small meals a day so that the stomach does not become overly full. Consuming several liquid meal replacements a day may help stabilize blood glucose levels. These provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.
Avoidance of fatty and high-fibre foods may aid digestion, as fat naturally slows digestion and fibre is difficult to digest. Some high-fibre foods, such as oranges and broccoli, contain material that cannot be digested easily and remain in the stomach too long, possibly causing blockages.
If a liquid or pureed diet does not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy, is inserted through the skin on your abdomen into the small intestine. The feeding tube bypasses the stomach and places nutrients and medication directly into the small intestine. These products are then digested and delivered to your bloodstream quickly. You will receive special liquid food to use with the tube. The jejunostomy is used only when gastroparesis is severe or the tube is necessary to stabilize blood glucose levels in people with diabetes.
Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. The doctor places a thin tube called a catheter in a chest vein, leaving an opening to it outside the skin. For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your doctor will tell you what type of liquid nutrition to use.
This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult period with gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.
Different drugs or combinations of drugs may be used to treat gastroparesis. These include metoclopramide, which stimulates stomach muscle contractions to help emptying and reduces nausea and vomiting; and, erythromycin, an antibiotic that also improves stomach emptying. Erythromycin works by increasing the contractions that move food through the stomach. Remember to discuss the risk of side effects of any medication with your doctor.
If you experience any digestive problem for more than a few weeks, it is important to speak to your physician or diabetes educator, who can help to determine the steps you can take to control the problem.