Digestive Complications

Gastroparesis, or delayed stomach emptying, literally means stomach weakness. 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 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 the following:

  • Nausea

  • Vomiting

  • Abdominal bloating

  • Weight loss

  • Premature feeling of fullness

Dealing with Gastroparesis

Gastroparesis, or slowed digestion that is a form of autonomic neuropathy, can make blood glucose levels hard to handle. People with gastroparesis who take insulin frequently need to adjust their dosage. Insulin lispro (Humalog, Novolog, Apidra) 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 eating 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 required.

For cases that are nonresponsive to dietary changes, injections of botulinum toxin (botox) 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.

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 metoclo-pramide (Reglan, a muscle stimulant), erythromycin (an antibiotic that can speed stomach emptying), and domperidone (Motilium). Domperidone is not approved for use in the United States, but is available in Canada and Europe. U.S. physicians who want to prescribe the drug for gastroparesis patients must complete an Investigational New Drug Application (IND). An IND is a request for FDA authorization to import and administer the drug.

Another medication, cisapride (Propulsid), was withdrawn from the U.S. market by manufacturer Janssen Pharmaceutica in 2000 but is also 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 2008. HUD status means that the device is conditionally cleared by the FDA for use at certain health care centers for treatment of specific rare diseases and conditions.

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