Tips To Make The Most Of Your Diabetes Management Plan
1. Understand the medicines you are taking and take them exactly as directed.2. Know what your target blood glucose level is and what to do if your numbers are out of range. Check your blood glucose levels as often as your health care provider recommends and keep a record.3. Watch for signs and symptoms of high blood glucose.4. Follow your meal plan and be aware of foods that can cause your blood glucose to go up.5. Be as physically active as you can.6. Have a sick-day plan and follow it.
Understanding diabetic gastroparesis
How Do Healthcare Providers Diagnose Diabetes
Its challenging to figure out if diarrhea you experience is due to diabetes or another condition. Your healthcare provider may ask you to keep a journal to keep track of your bowel movements, including frequency and severity.
You may need to work with a gastroenterologist, a specialist in the digestive system.
Small Intestinal Bacterial Overgrowth
We dont really understand the small intestinal bacterial overgrowth GI problem. SIBO occurs in diabetes when the blood sugars are too high for a long time period. Excessive bacteria colonizes in the small intestine and often mimics irritable bowel syndrome or IBS. The symptoms include bloating, diarrhea, stomach discomfort and weight loss. This could be due to damage to the enteric nervous system .
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How Do I Know If I Have Diabetic Stomach
There are a number of diabetic stomach symptoms. The following questions might help you determine if you have the condition:
- Have you had any recent changes in appetite?
- Do you feel full, even though you havent eaten very much?
- Have you been having unexplained nausea?
- Have you had bloating?
- Have you had any abdominal cramping or pain?
- Have you had unexplained vomiting of undigested food, especially in the morning?
- Have you been having trouble controlling your blood sugar?
- Have you gained or lost weight recently?
- Have you experienced diarrhea or constipation recently?
Common Gi Conditions In Those With Diabetes
While the GI tract is a complicated one and many people with diabetes can suffer from a variety of GI conditions, there are some more common ones that they are often diagnosed with. They include:
Gastroparesis
Gastroparesis is a condition where the process of emptying the food in the stomach is delayed which creates a retention of the contents in the stomach. People with gastroparesis often experience bloating, distention of the stomach, abdominal pain, vomiting and nausea. Foods that contain a high amount of fiber or fat are not tolerated by many people with gastroparesis and can lead to an increase in heartburn and reflux issues.
Diagnosing Gastroparesis
Many patients are diagnosed with gastroparesis based on their symptoms alone. However, additional testing is done to confirm this diagnosis. An upper GI endoscopy can rule out any obstructions in the stomach or the duodenum, but this test does not give an accurate picture of the gastric emptying process. To confirm ma delay in gastric emptying an upper GI barium study may be necessary.
Treatment of Gastroparesis
Candida Infections
Ulcer Disease
Enteric Neuropathy in the Small Intestine
Enteric neuropathy can also lead to chronic pain in the abdomen, similar to that of the peripheral neuropathy in ones feet which can occur as a long-term complication of diabetes. Treatment of chronic enteric neuropathy includes pain medications and antidepressants.
Celiac and Diabetes Connection
Fatty Infiltration or Liver Disease
Wrap-Up
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How Does Gastroparesis Affect People With Diabetes
People with diabetes are at increased risk for gastroparesisa digestive disorder that can cause severe symptoms and affect quality of life.
Diabetes is the most common known cause of gastroparesis, a digestive disorder that may lead to poor nutrition, problems managing blood glucose, and a reduced quality of life. Here, Dr. Adil E. Bharuchaone of the authors of the chapter, Gastrointestinal Manifestations of Diabetes, in the NIDDK publication Diabetes in America, 3rd Editiondiscusses how health care professionals can diagnose and treat gastroparesis in patients with diabetes.
Q: What is gastroparesis? How common is gastroparesis in people who have type 1 or type 2 diabetes?
A: Gastroparesis is a condition in which the muscles in the wall of the stomach work poorly or dont work at all, slowing or delaying the rate at which food empties from the stomach to the intestine. This is called delayed gastric emptying. In gastroparesis, gastric emptying is delayed because the muscles dont work effectively, not because a blockage prevents food from moving from the stomach to the intestine.
In one study, over a period of 10 years, about 5% of people with type 1 diabetes and about 1% of people with type 2 diabetes developed gastroparesis. Less than 1% of people without diabetes developed gastroparesis during the study.
Q: In people with diabetes, what is the relationship between gastroparesis and blood glucose levels?
Q: How is gastroparesis diagnosed?
Management And Treatment Of The Disease
Diabetic Gastroparesis/Gastropathy
Management of gastroparesis requires optimization of glycemic control both acute and chronically. Blood glucose levels > 270 mg/dL prolongs gastric emptying time.
Dietary Recommendations: Vitamin and mineral deficiencies may be seen in patient with gastroparesis due to food intolerance. Diet modifications are needed to compensate for impaired gastric motor and sensory function. The gastroparesis diet requires 4-6 small, low fat, low fiber meals each day . Patients may be dependent on high calorie liquids to meet their caloric and nutritional needs during flares when they are unable to tolerate solid food. Carbonated beverages and alcohol should be avoided. In severe cases, patients may need a jejunal feeding tube to bypass the stomach.
Medication Therapy: Medications used for diabetic gastroparesis include prokinetic drugs that stimulate gastric emptying and symptomatic treatment with antiemetic agents, and neuromodulators that blunt gastric nerve hypersensitivity.
Prokinetic Therapy
Erythromycin is a motilin agonist that is most effective when used intravenously at 3 mg/kg every 8 hours. While it may be given in oral formulation, studies have shown that long term use leads to downregulation of the motilin receptor, and as a result, the medication becomes ineffective. Drug interactions with CYP3A4 activity and QT prolongation may occur.
Symptomatic Management
Small Intestinal Bacterial Overgrowth
Diabetic Constipation
Table V.
Table VI.
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Gastroparesis Affects 12 To 15% Of People Living With Diabetes
What is gastroparesis?
Gastroparesis is a condition when the stomach takes a long time to empty its contents into the small intestine. It is also referred to as delayed gastric emptying, gastric stasis, slow stomach, lazy stomach, and diabetic enteropathy. It usually occurs in people who have been living with diabetes for at least 10 years, and typically presents together with complications of the eye, kidney and others linked to the nervous system.
Normally, when food is swallowed, the muscles in the stomach wall help break the food down into smaller pieces, pushing it into the small intestine to continue digestion. This action is controlled by the vagus nerve, part of the so-called autonomic nervous system, which automatically regulates many bodily functions such as breathing and heart rhythm. If the vagus nerve is damaged or stops working, the muscles in the stomach and intestines do not function normally, and the movement of food stops or slows down. If the food stays in the stomach too long, the food ferments and causes an overgrowth of gas-producing bacteria.
Advice For People With Diabetes
Having gastroparesis means your food is being digested slowly and at unpredictable times. If you also have diabetes, this can have a big effect on your blood sugar levels.
The nerves to the stomach can be damaged by high levels of blood glucose, so it’s important to keep your blood glucose levels under control if you have diabetes.
Your doctor can advise you about any changes you may need to make to your diet or medicine. For example, if you’re taking insulin, you may need to divide your dose before and after meals and inject insulin into areas where absorption is typically slower, such as into your thigh.
You’ll also need to check your blood glucose levels frequently after you eat.
Page last reviewed: 14 October 2019 Next review due: 14 October 2022
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When To Contact Your Doctor
Contact a doctor if youre experiencing frequent diarrhea. Theyll look at your health profile and assess your blood sugar levels. They may also perform a brief physical exam to help rule out any other medical conditions.
Before you start a new medication or another treatment regimen, your doctor will want to be sure youre not experiencing any other gastrointestinal issues.
- taking loperamide before meals to manage symptoms
- taking clonidine to regulate bowel movements and reduce spasms
- taking amitriptyline to reduce cramping and slow digestion
- practicing pelvic floor training, and possibly getting a colostomy, for people with fecal incontinence
Depending on their assessment, your doctor may refer you to a gut specialist called a gastroenterologist for further investigation.
Scary Signs You Have Vitamin D Deficiency
Wondering why you cant seem to shake that cold or stomach infection with medication? Chances are an underlying Vitamin D deficiency could be jeopardising your recovery.
Vitamin D is stored and synthesised in the body naturally, activated by the liver and kidney when exposed to the sun . Its key to maintaining calcium and phosphate levels in the body as well as keeping our immune system healthy.
Several factors have contributed to the rising incidence of Vitamin D deficiency. The main one being lack of proper exposure to sunlight because we dont spend enough time outdoors. Our sedentary lifestyle is another problem. Its found that people who are overweight/obese are more prone to Vitamin D deficiency. Since Vitamin D is a fat soluble compound , a high fat deposition in the body creates a greater demand for Vitamin D. Research has also shown people with dark skin pigmentation are more at risk as their skin colour blocks the suns ability to stimulate Vitamin D production. Genetic and other medical conditions such as liver and kidney disease can also cause a shortfall.
A Vitamin D deficiency isnt easy to diagnose, as it doesnt always cause symptoms until levels become very low or have been low for some time. But some of more alarming signs to watch out for include:
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Lauras Advice To Other Patients Struggling With Gastroparesis
First and foremost, Laura says its crucial to make sure youre researching the condition yourself , and make sure youre using credible sources when learning about potential treatments.
I found that I had to accept that many healthcare professionals did not have a great understanding about the condition however, I do appreciate their honesty in telling me this. And we have worked together to manage it as best we can.
Laura absolutely recommends joining social media forums or support groups to talk to others about their own methods of managing the grueling symptoms of gastroparesis.
The patients really are the experts, and they have many tricks up their sleeves to make living with this difficult condition more manageable.
If you found this guide to diabetic gastroparesis helpful, please sign up for our newsletter in the form below. We send out a weekly newsletter with the latest posts and recipes from Diabetes Strong.
Gi Tummy Problems And Diabetes
With diabetes the most common complications usually discussed involve the cardiovascular system: the heart and blood vessels. Diabetes elevates the risks of heart attack, stroke and peripheral vascular disease. People with diabetes can also have complications in their kidneys, eyes and feet. These are related to nerve ending problems. The GI is not a common topic when reviewing your blood sugars. Up to 75% of patients with long standing diabetes report chronic, intermittent GI complaints. The entire GI tract may be affected by diabetes starting in the oral cavity which includes the mouth and esophagus, to the small bowel, the large bowel and the rectal region.
The medical world realizes the GI tract is known as the second brain of your entire body. Patients may feel uncomfortable or embarrassed talking to their physician about stomach issues as bathroom habits seem to be a private matter. Many of you feel squeamish and that the information is just too personal to discuss, even with your doctor. You assume it will simply go away. The topic is neglected and you may suffer in silence. There are multiple studies citing that, GI problems are prevalent among people with type 1 and type 2 diabetes.
Poor diabetes control and how long you have had diabetes play a big role in developing GI symptoms. Common GI complaints experienced by people with diabetes may include:
- difficulty swallowing
- gas, bloating, or diarrhea
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High Blood Sugar Or Hyperglycemia
Hyperglycemia can negatively affect elderly or undiagnosed chronic diabetic patients. If untreated, abnormally high blood glucose levels result in severe complications like diabetic ketoacidosis. It is your bodys response to deficient insulin. Abdominal pain or nausea, vomiting, dehydration are a few symptoms.
Preventive Measures
- Immediate Insulin and fluid administration is essential
- Regulate your glucose levels through medication and a balanced diet. You can choose low glycemic index foods, which will not increase your glucose levels. For example, you can consume whole-grain food and low carbohydrate foods like fruits, vegetables, seafood, etc.
- Regular exercise helps cells to absorb insulin better. In addition, it helps in sugar absorption and energy release by cells. Thus, helping maintain a proper glucose level. Furthermore, exercise also helps regulate stress levels. Stress initiates the release of cortisol or stress hormones. Cortisol renders the cells resistant to insulin, triggering high blood glucose.
- Monitor your glucose levels regularly and inform your healthcare professional in case of any abnormal change. They will alter your medicine dosage.
- Strict and nonnegotiable adherence to medication and guidelines are necessary. It helps to keep glucose levels in control.
Let Your Stomach Rest
When you are treating vomiting due to a stomach bug, or gastroenteritis, the first step is to let your stomach rest. After you stop throwing up, dont try to eat or drink anything for 15 to 20 minutes so you can allow your stomach time to recover.
Giving the muscles in your stomach time to rest will lower the chances that you will vomit once you start eating and drinking again.
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Gastroparesis Is A Gastrointestinal Condition Occurring In People With Long
with Mahdusudan Grover, MD, and Michael Camilleri, MD
Gastroparesis gets little attention even though it is a relatively common complication arising in many individuals with diabetesboth type 1 diabetes and type 2 diabetes. Its even more common in individuals with both diabetes and obesity.1
If you have diabetes, stomach pains, bloating, and nausea may be a sign that you gastroparesis. Photo: 123rf
Common symptoms include feeling full before you can finish your meal and staying full long after the meal is over as well as bloating, nausea, vomiting, abdominal pain, and even nutritional deficiencies.1,2
According to results of one study,3 as many as 29% of patients with these gastric symptoms also have diabetes and may experience nerve problems in their stomach, similar to that of peripheral neuropathy that causes tingling and numbness, even pain, in the extremities. Poor blood sugar control may also be a contributing factor.4
If you have had diabetes for a while, this might explain the abdominal pain and other baffling symptoms youve been experiencing after you eat.
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Importance Of Nutrition As Treatment In Gastroparesis
The initial treatment in patients with gastroparesis is to create a diet that will improve the symptoms. Your physician may recommend eating frequent small meals and to avoid fatty, spicy, acidy and high fiber foods. Your physician may also recommend soups or more liquid containing meals..
In addition, we always want to make sure our patients are well hydrated.
Those patients with diabetes should have good control of their sugars.
Medicines that delay stomach emptying should be avoided if possible.
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Type 1 Diabetes And Celiac Disease
6% of people with type 1 diabetes will develop celiac disease. There is a genetic link, and both are considered autoimmune diseases. Having celiac disease makes controlling diabetes even more difficult, since food and medications do not absorb well. Symptoms of celiac disease for some may include chronic fatigue, bone pain, neuropathies and migraines. Other classic GI symptoms are gas, bloating, diarrhea, constipation, vomiting, weight loss and anemia. People with type 1 diabetes usually have no symptoms of celiac disease and must be tested with specific blood tests.
The immune system responds to gluten, a protein in wheat, bran, wheat germ, rye, barley, in certain individuals. It causes mucosal thinning and inflammation. The response to gluten damages the small intestine leading to malabsorption. The only treatment is a strict gluten-free diet. Following a strict gluten-free diet can help the intestinal damage heal over several months. Fortunately, there are many gluten free products presently on the market. Working with a registered dietitian for both diabetes and celiac disease is always worthwhile.
Drugs That Treat Diabetic Kidney Disease
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