Patients with long standing diabetes usually have some evidence of damage to the nervous system, or neuropathy. If you have neuropathy you may be familiar with pain, tingling, numbness or loss of feeling in the feet or hands (called peripheral neuropathy), but it can affect any organ system, including the stomach and its related organs.
Nerve damage associated within the gastrointestinal tract can result in the motility disorders of gastroparesis and small bowel bacterial overgrowth (SBBO). Gastroparesis is 2 to 3 times more common in type 1 diabetes than type 2 diabetes and may affect as many as 50 percent of those with type 1.
If you eat a low-fat, mixed meal your blood glucose will peak in about 1.5 hours. With normal bowel function, this peak coincides with the peak action of rapid acting insulin.
But damage to the nerves (the vagus nerve) of the gastrointestinal tract causes a loss of stomach and intestinal motor control. This can lead to a mismatch between when you digest food and glucose enters the blood stream and the action time of insulin.
If you have gastroparesis you may experience erratic blood glucose, with a pattern of low glucose readings shortly following the meal and elevated readings hours after eating.
Symptoms include nausea, early satiety, vomiting and in severe cases weight loss. Because of gastric stasis and slower bowel transit times, patients are also prone to constipation.
Gastroparesis is diagnosed by gastric emptying studies. In this test, patients are fed a meal containing a marker isotope and x-ray pictures are taken of the stomach over a 4 hour period.
Severe gastroparesis can lead to malnutrition due to continued vomiting and poor consumption of calories and protein. The goals of nutrition therapy are to prevent muscle loss, provide adequate vitamin and mineral intake, control blood glucose levels and relieve symptoms.
Nutrition recommendations include
1. Eat smaller, more frequent meals;
2. Consume more of your calories with liquids. Liquids pass more quickly than solids through the stomach;
3. Limit dietary fiber especially, for patients prone to bezoars (those are hairball like accumulations of hardened food fibers, and they can lead to obstruction of the passage from the stomach to the intestine)
4. Reduce dietary fats –especially solid fats – as they delay gastric emptying. Fats in liquid form appear better tolerated
5. Consume adequate calories to achieve or maintain a healthy weight
Other recommendations include:
1. Control of blood glucose- high levels (greater than 270 mg/dl) delay GI transit time.
2. Taking insulin after the meal or for patients using an insulin pump, use the extended action bolus.
3. Using a combination of prokinetic (movement stimulating) and antiemetic (anti nausea and vomiting) agents to improve gastric motility and control symptoms of nausea and vomiting.
For patients who do not find relief with the above measures, gastric electric stimulation can be attempted. A small pulse generator is placed under the skin and wires are attached to the stomach. The generator emits a small charge stimulating stomach emptying.
But, as always, talk to your doctor before making any changes to your diet or care.