Gastroparesis (Delayed Gastric Emptying) And Diabetes Type 2: Symptoms, Causes, And Treatment

Diabetes is associated with a range of complications, one of which is gastroparesis — delayed gastric (stomach) emptying. Gastroparesis is a disease of the digestive system in which the food stays in the stomach for a much longer period of time than average.

Research shows that gastroparesis occurs because the nerves that signal muscles to move the food throughout the digestive tract become damaged. Thus, any food the patient has ingested will just stay in the stomach undigested. Gastroparesis is largely linked to diabetes and has been shown to progress over time, particularly in patients with untreated diabetes and thus, high levels of sugar in their blood.

What symptoms does gastroparesis cause?

While gastroparesis itself is a symptom of diabetes, gastroparesis has its own set of symptoms. They include:

• Heartburn (acid reflux)
• Nausea and vomiting up the undigested food
• Feeling very full after a small meal
• Unexplained weight loss
• Feeling bloated
• Lost appetite
• Uncontrollable blood glucose levels
• Spasms of the stomach

The symptoms can either be very mild or very severe, depending on the level of damage that has been done to the nerve that extends from the brain and to the digestive tract and abdominal system. Symptoms can develop at any time but have been shown to commonly present after consuming foods high in fiber and fat and slow to digest.

Risk factors for gastroparesis

Interestingly, research has shown that women with diabetes are more likely to develop gastroparesis than men with diabetes.

Furthermore, if you have other certain other diseases or conditions in addition to diabetes, this also increases your risk of developing gastroparesis:

• Viral infections
• Acid reflux
• Diseases that affect the smooth muscles (the muscles that control stomach emptying)

Other diseases can lead to symptoms associated with gastroparesis, too — including Parkinson’s disease, chronic pancreatitis (inflammation of the pancreas), cystic fibrosis, kidney disease, and Turner’s syndrome.

What causes gastroparesis?

Patients develop gastroparesis because they sustain damage to a nerve that controls the actions of the muscles responsible for stomach emptying. This nerve is known as the vagus nerve. Damage to the nerve causes it to no longer function properly, rendering the body unable to digest food normally because there are no more signals from the brain that tell the digestive tract to churn the food. However, gastroparesis is very difficult to diagnose, particularly if the symptoms are mild. Many people just attribute it to a food sensitivity, chronic heartburn, nausea, or a stomach ache, causing it to be misdiagnosed or undiagnosed.

Gastroparesis and diabetes

Gastroparesis is fairly common in patients with diabetes. In fact, studies have estimated that the prevalence of gastroparesis in patients with type 1 diabetes is between 27 to 58 percent. The prevalence of gastroparesis in patients with type 2 diabetes has been estimated to be 30 percent. Within the population of patients with diabetes, gastroparesis is most common in those who have very high and uncontrolled levels of glucose in the blood for a long period of time. This is because, the longer you have high blood sugar levels, the more damaged your nerves are going to be. The damage to the nerves, including the nerves that supply the digestive tract, causes them to no longer receive adequate levels of nutrition and oxygen.

Complications of gastroparesis

There are several complications that can result from gastroparesis. When food is not moving through the digestive tract, it just sits or remains inside the stomach and causes feelings of being full and bloated. Furthermore, when the food just sits in the stomach, it turns into a solid mass called bezoar, which can cause nausea, vomiting and obstruction of the small intestine.

In particular, gastroparesis can cause significant complications for patients with diabetes as people experience delays in digesting foods, which can make controlling blood sugar levels quite difficult. Since it is hard to track exactly when a patient will be able to digest their food, it can cause glucose readings to go up and down. Therefore, it is recommended that if you find your glucose readings fluctuating, you should go see a doctor as that can indicate underlying gastroparesis. 

How is gastroparesis managed?

Unfortunately, gastroparesis is a chronic (long-term) condition and it can be overwhelming to deal with any chronic condition. However, working with a doctor and following treatment regimens can help you live and a long and healthy life. 

One of the biggest changes that patients with gastroparesis need to make is changes to their diet. Patients need to avoid foods that are:

• High in fiber
• High in fat

Instead, patients should be eating foods that are:

• Raw
• Fruits and vegetables
• Dairy products
• Carbonated beverages

Additionally, doctors recommend that you eat small meals throughout the day and blend your foods if you need to. You also need to make sure you stay hydrated, particularly if you are vomiting. One possible treatment for gastroparesis is gastric electrical stimulation. This is only for the severe cases of gastroparesis and involves the surgical implantation of a device into your abdomen that delivers electrical pulses to the muscles of your stomach.

Finally, your doctor will likely change your insulin dose and regimen as needed. For example, your doctor may tell you to start taking insulin after your meals instead of before and to check your blood glucose levels frequently after your meal.