Diabetic Gastroparesis

Diabetic Gastroparesis

DIABETIC GASTROPARESIS

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.