Good Life

People Centre’d On Diabetes: Gastroparesis is a challenging complication

Living with diabetes is challenging. It’s a chronic disease — never letting up, never going away. And it’s an insidious disease, causing harm gradually so that a complication can be well established before symptoms develop.

Many of the complications of diabetes are well known: damage to eyes, kidneys and nerves in feet, and also greater risk for heart attacks and strokes. Even though this is less well known, one of the most challenging complications of diabetes is gastroparesis, or delayed stomach emptying.

Normally once you swallow what you are eating, the food passes through the esophagus into the stomach. There stomach acid and churning break down the food, after that food should move into the small intestine where nutrients are extracted.

Just as nerves in the feet can be damaged by diabetes, so can internal nerves that control organs, such as the vagus nerve. The vagus sends signals to muscles of the stomach to contract to move food out of the stomach into the small intestine. Gastroparesis, stomach paralysis, means the food doesn’t move like it should.

Because of this, the nutrients you were expecting within two hours of eating take longer to enter the bloodstream. This really plays hob with glucose control if you take insulin to manage diabetes. For healthy folks — and they can develop gastroparesis too, this isn’t an issue. Natural insulin levels increase only as nutrients, (especially sugar) are entering the bloodstream, even when this is delayed.

When there’s a delay in emptying the stomach, and a person injects insulin as usual just before eating, that synchronization flare up doesn’t happen. Insulin gets into the bloodstream first and drops the blood sugar levels lower than normal. Then, when the delayed nutrients (including sugar) enter the system, the insulin is already done, resulting in much higher sugar levels.

What if you take the insulin shot later? It doesn’t work. The delay in food absorption is not consistent. Some days, some meals move much slower or faster than others, making the timing of insulin shots much more challenging.

What can be done about gastroparesis? There are not a lot of very good medical responses once gastroparesis has reared its ugly head. Fortunately no one dies from gastroparesis. Treatment revolves around dealing with the symptoms: bloating, gas, heartburn, regurgitation and vomiting. There are one or two medications, but they have serious side effects. Ginger and peppermint — centuries-old mainstays for stomach upset — can provide relief.

Diet changes also help — not just what is eaten, but how. Smaller portions more frequently throughout the day and more thorough chewing, or in extreme cases pureeing foods in a blender, can help. Foods that often work best in controlling blood sugars (proteins, fats and fiber) make the gastroparesis worse. These types of foods slow digestion. Starchy foods without a lot of fiber are much easier to digest but raise blood sugar too quickly. Choosing the right foods is a balancing act.

Plus, somehow one has to guess the insulin time and dose to keep healthy blood sugar levels.

Ultimately the best defense is an awesome offense. All of the complications of Type 2 diabetes are preventable. Increase your activity levels. Be more mindful of what you eat. Reduce your stress levels, regardless of the source. If you haven’t yet been diagnosed, but are at risk, this will help prevent/delay diabetes. Also get tested for diabetes at least every two years. If you have been diagnosed, these kinds of practices will greatly reduce the chance of developing complications like gastroparesis.