Are you someone who has diabetes? So, do you sometimes feel full even after eating a small amount of food? Or do you often feel nauseous, have heartburn, and sometimes vomit? With all these things, you may be struggling to control your blood sugar levels. Many people think that these are just normal stomach problems. But this can be a complication of diabetes itself. That's what we're going to talk about today.
What is Diabetic Gastroparesis?
Simply put, this is when the muscles in your stomach (stomach) don't work properly. Normally, when we eat, the muscles in the stomach contract and push the food into the small intestine. But in gastroparesis, this process happens very slowly, or sometimes stops altogether. So the food stays in the stomach for hours.
This condition can be seen in both type 1 and type 2 diabetes. However, it most often occurs in people who have had diabetes for more than 10 years and who have other complications from diabetes (for example, nerve damage).
Why is this happening to us?
The main reason for this is that blood sugar levels remain high for a long time without control . Uncontrolled diabetes can damage the nerves in our body.
Imagine that there is a master "controller" that controls the functioning of our stomach. That is the Vagus nerve . When this Vagus nerve is damaged due to high sugar levels, the stomach does not receive the signal to empty the food properly. It can also damage the muscles in the stomach and the special cells (pacemaker cells) that help push the food through. When all these reasons come together, food gets stuck in the stomach and gastroparesis occurs.
What are the main symptoms of this?
Take a look to see if you have these symptoms. But remember, don't assume that you have this disease just because you have one or two of these symptoms. You should definitely see a doctor for that.
| Symptom | A simple explanation |
|---|---|
| Heartburn/Reflux | Acidic food in the stomach comes back up into the throat. |
| Nausea | Discomfort that feels like vomiting all the time. |
| Vomiting | In severe cases, undigested food eaten hours before may be vomited. For some, this can happen daily. |
| Difficulty controlling sugar levels | Since it is impossible to tell exactly when food enters the intestines, sugar levels can rise and fall suddenly. |
| Feeling full even after eating a little | Because the stomach has previously stored food, you feel full even after eating a small amount. |
| Abdominal bloating | Feeling bloated, as if the stomach is full of air. |
| Loss of appetite and weight loss/gain | You don't feel like eating because your stomach is always full. This can lead to weight loss. |
What are the situations where this could be dangerous?
If gastroparesis is not treated properly, certain complications can occur.
- Food spoilage: When food stays in the stomach for too long, it can spoil and cause bacteria to grow.
- Bezoar formation: Undigested food can accumulate and form a solid mass inside the stomach. This is called a bezoar . This can block the stomach and completely stop food from passing into the intestines.
- Difficulty controlling diabetes: This is the biggest problem. You take insulin before eating. But the food goes into the intestines and the sugar gets into the blood after several hours. Then the sugar level goes up and down suddenly. This is very difficult to control.
- Dehydration due to vomiting: If you vomit frequently, your body can lose water and become dehydrated. This is a dangerous condition.
If you have severe vomiting and severe stomach pain, go to the Emergency Department (ETU) immediately.
How do you find this, Doctor?
Your doctor may suspect this after listening to your symptoms and performing a physical exam. They may then perform several tests to confirm the diagnosis, such as:
- Upper Endoscopy: A thin tube with a camera attached is inserted down the throat to examine the inside of the stomach. This helps to check for any other blockages in the stomach.
- Barium X-ray: After drinking a liquid called barium, an X-ray is taken to check the speed of stomach emptying.
- Scintigraphy: This is the main test. You eat a small amount of food (usually an egg) mixed with a radioactive substance, and then you scan your stomach every hour for about 4 hours to see how much of the food has been emptied from your stomach.
- Other tests: In addition, there are specialized tests such as gastric manometry and wireless motility capsule. Your doctor will decide which test is right for you.
Treatment and management
Although gastroparesis cannot be completely cured, symptoms can be managed and a normal life can be lived.
1. First and foremost: control your blood sugar levels!
This is the first and most important step in treatment. Controlling your blood sugar levels can help reduce nerve damage. Talk to your doctor about whether you need to adjust your insulin dose or timing. It is also important to check your blood sugar levels regularly.
2. Medications
Your doctor may prescribe certain medications to help relieve your symptoms.
- Medicines that help the stomach empty (e.g. Metoclopramide, Domperidone).
- Medicines for nausea and vomiting (e.g. Ondansetron, Prochlorperazine).
- Sometimes the antibiotic erythromycin is also given short-term to increase stomach function.
Warning: Never use these medications without consulting a doctor. Some medications can have side effects. Therefore, always follow your doctor's instructions.
3. Treatment for severe cases
In very severe cases that cannot be controlled with other treatments, special treatment methods may be required.
- Gastric electrical stimulation: A small device surgically attached to the stomach sends electrical signals to control nausea and vomiting.
- Feeding tube: A tube (jejunostomy tube) is surgically inserted through the skin of the abdomen to direct food into the small intestine, bypassing the stomach. This is only done in the most severe cases.
How to change your diet
Even more important than medication is changing your eating habits. Following these tips can help you get great relief.
| Things to do (Do's) | Don'ts |
|---|---|
| Instead of eating three meals a day, eat 5-6 small meals . | Avoid foods high in oil and fat (fried foods, oily curries). |
| Prioritize liquids and pureed foods (e.g., applesauce instead of an apple, soups). | Reduce foods high in fiber (brown rice, oats, some vegetables, fruits). These take longer to digest. |
| Eat vegetables and fruits well-boiled . | Avoid drinking water or other liquids while eating. Drink 30 minutes before or after meals. |
| Sit for a while after eating. Don't lie down while eating . | Avoid carbonated drinks (soda) and alcohol completely. |
| Do some exercise, like a light walk, after eating. | Avoid smoking . It further reduces stomach function. |
Take-Home Message
- Diabetic Gastroparesis is a common complication of poorly controlled diabetes.
- The main symptoms are nausea, vomiting, feeling full even after eating a small amount, and difficulty controlling blood sugar levels.
- The most important step in managing this condition is to keep your blood sugar levels well controlled.
- Changing your diet is very important. Eating small meals, low in fat and fiber, can provide great relief.
- If you have these symptoms, do not make decisions on your own and definitely see your doctor for advice.
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