Digestive Complications and Diabetes
Robin Brain
November 22, 2008
Gastroparesis, or delayed stomach emptying, literally means partial stomach paralysis. It is another type of autonomic neuropathy caused by damage to the vagus nerve, which is responsible for facilitating the passage of food through the digestive system. What makes gastroparesis a particular problem in people with diabetes is that it can greatly hinder your efforts at blood glucose control. If you can't predict how quickly your food will be digested, your insulin or medication could work too quickly or too slowly. Symptoms of gastroparesis may include:
Nausea
Vomiting
Abdominal bloating
Weight loss
Premature feeling of fullness
Dealing With Gastroparesis
People with gastroparesis who take insulin frequently need to adjust their dosage. Insulin lispro (Humalog) may be recommended since it starts working within minutes and peaks within an hour or two. If you have gastroparesis, your doctor can provide specific recommendations for insulin therapy for your particular situation. Adjustments to diet are also usually necessary to ease gastroparesis. High fat and high fiber foods are discouraged since they slow digestion. Your doctor may recommend smaller, more frequent meals, or replacing some meals with liquid based nutrition. In cases where vomiting is so extreme that you are having trouble keeping food down altogether, parenteral or jejunostomy (tube) feeding may be equired. Jejunostomy involves insertion of a feeding tube through the abdomen and into the small intestine. A liquid nutritional compound is then administered through the tube. Parenteral nutrition uses an intravenous line directly into the bloodstream to provide vital nutrients. It is usually only used as a temporary measure while treatment by other means is stabilized. For cases that are nonresponsive to dietary changes, injections of botulinum toxin into the sphincter of the pylorus (the opening connecting the stomach to the small intestine) may be attempted in an effort to relax the opening to let food pass through more readily.
E Fact
Gastroparesis occurs most frequently in people with type 1 diabetes, affecting an estimated 20 percent of people with the disease. But it can also occur in type 2 diabetes. Medication may also be prescribed to try to speed up digestion. Commonly prescribed gastroparesis medications include metoclopramide (Reglan, a muscle stimulant), erythromycin (an antibiotic that can speed stomach emptying), and domperidone (Motilium). Domperidone was not approved for use in the United States as of early 2003, but is available in Canada and Europe. Another medication, cisapride (Propulsid), was withdrawn from the U.S. market by manufacturer Janssen Pharmaceutica in 2000, but is still available for qualified patients through a compassionate use program developed by Janssen and the FDA. Enterra Therapy (Medtronic), a device that uses electrical impulses to stimulate digestion by the stomach, has been successful in treating chronic gastroparesis in some patients for whom drug therapy was not effective. Often described as a pacemaker for the stomach, Enterra is approved as a Humanitarian Use Device by the FDA as of early 2003. HUD status means that the device is conditionally cleared for use in specific rare diseases and conditions by the FDA.
Nausea
Vomiting
Abdominal bloating
Weight loss
Premature feeling of fullness
Dealing With Gastroparesis
People with gastroparesis who take insulin frequently need to adjust their dosage. Insulin lispro (Humalog) may be recommended since it starts working within minutes and peaks within an hour or two. If you have gastroparesis, your doctor can provide specific recommendations for insulin therapy for your particular situation. Adjustments to diet are also usually necessary to ease gastroparesis. High fat and high fiber foods are discouraged since they slow digestion. Your doctor may recommend smaller, more frequent meals, or replacing some meals with liquid based nutrition. In cases where vomiting is so extreme that you are having trouble keeping food down altogether, parenteral or jejunostomy (tube) feeding may be equired. Jejunostomy involves insertion of a feeding tube through the abdomen and into the small intestine. A liquid nutritional compound is then administered through the tube. Parenteral nutrition uses an intravenous line directly into the bloodstream to provide vital nutrients. It is usually only used as a temporary measure while treatment by other means is stabilized. For cases that are nonresponsive to dietary changes, injections of botulinum toxin into the sphincter of the pylorus (the opening connecting the stomach to the small intestine) may be attempted in an effort to relax the opening to let food pass through more readily.
E Fact
Gastroparesis occurs most frequently in people with type 1 diabetes, affecting an estimated 20 percent of people with the disease. But it can also occur in type 2 diabetes. Medication may also be prescribed to try to speed up digestion. Commonly prescribed gastroparesis medications include metoclopramide (Reglan, a muscle stimulant), erythromycin (an antibiotic that can speed stomach emptying), and domperidone (Motilium). Domperidone was not approved for use in the United States as of early 2003, but is available in Canada and Europe. Another medication, cisapride (Propulsid), was withdrawn from the U.S. market by manufacturer Janssen Pharmaceutica in 2000, but is still available for qualified patients through a compassionate use program developed by Janssen and the FDA. Enterra Therapy (Medtronic), a device that uses electrical impulses to stimulate digestion by the stomach, has been successful in treating chronic gastroparesis in some patients for whom drug therapy was not effective. Often described as a pacemaker for the stomach, Enterra is approved as a Humanitarian Use Device by the FDA as of early 2003. HUD status means that the device is conditionally cleared for use in specific rare diseases and conditions by the FDA.
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