Gastroparesis, "delayed gastric emptying," is one of the more serious ramifications of diabetes. We tend to take the working of the stomach and intestines for granted, until they stop working properly. The digestive tract is closely controlled by the brain, via the autonomic nerves.

Problems come with the development of neuropathy. Extended periods of time with high blood glucose, or with the uremic toxicity that follows kidney failure, can damage nerve fibers, and when the autonomic nerves are damaged, stomach function can become increasingly unpredictable. As with neuropathy itself, an individual may have mild to severe symptoms of gastroparesis.

Gastroparesis may cause: early satiety (feeling "full" almost immediately after starting to eat), abdominal bloating, gastric pain, nausea, and vomiting. The gastroparesis sufferer may burp or vomit up food consumed many hours before--and find it nearly undigested. The nausea, vomiting, and dehydration may become severe enough to require hospitalization.

Anorexia, unwillingness to eat, can become a factor. With so much frustration and difficulty digesting food, the person simply chooses not to eat, rather than be sick all the time. This creates further problems with blood sugar control, and may lead to malnutrition.

Gastroparesis alone is a double handful for anyone struggling to cope. When it follows diabetes, it can become far more serious. The "backbone" of diabetes self-management is good scheduling--but such scheduling assumes that food taken on time will be digested on time. The diabetic forever juggles food, insulin and/or oral medications, exercise, and time-of-day, to optimize blood glucose level. Gastroparesis' unpredictability injects a new variable into the equation, as the digestive system may function on time, late, or not at all.

Meals may be missed; oral medications undigested. The correct amount of insulin, taken with a meal, may throw the individual into hypoglycemia when the meal remains undigested. Compensating for expected difficulties, that do not then materialize, the diabetic may experience hyperglycemia.

The serious consequences of severe gastroparesis are a ringing argument for good, consistent diabetes self-management, adopted before such ramifications have the opportunity to develop. The Diabetes Control and Complications Trial (DCCT) proved that "tight control" of blood glucose radically diminished the likelihood of such complications as neuropathy, nephropathy, retinopathy, and gastroparesis.

Diabetes is a sneaky disease. You may do your best, and still experience severe complications, or, you may have developed the condition years before the DCCT, back when we didn't know so much about good control. If you have gastric difficulties, talk to your doctor. Gastroparesis is just one of many conditions that can interfere with digestion.

If your doctor determines that you have gastroparesis, a number of options are open, depending on the severity of your symptoms. Medications such as Metoclopramide, Bethanecol, Domperidone, Cisapride (Propulsid) and, surprisingly, the antibiotic Erythromycin, bring some relief. Your diet may need adjustment, toward easy-to-digest foods.

Not enough is known about gastroparesis, or about the neuropathy that produces it. Future studies should give us better tools to deal with this ramification. We do know that diabetics who get their blood sugars under good control and keep them there often see a lessening in the severity of complications. It is never too late to improve your control.