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 don’t 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?
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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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:
Gastroparesis In A Patient With Diabetic Ketoacidosis
A 40-year-old man with type 1 diabetes mellitus and recurrent renal calculi presented to the emergency department with nausea, vomiting, and abdominal pain for the past day. He had been checking his blood glucose level regularly, and it had usually been within the normal range until 2 or 3 days previously, when he stopped taking his insulin because he ran out and could not afford to buy more.
He said he initially vomited clear mucus but then had 2 episodes of black vomit. His abdominal pain was diffuse but more intense in his flanks. He said he had never had nausea or vomiting before this episode.
In the emergency department, his heart rate was 136 beats per minute and respiratory rate 24 breaths per minute. He appeared to be in mild distress, and physical examination revealed a distended abdomen, decreased bowel sounds on auscultation, tympanic sound elicited by percussion, and diffuse abdominal tenderness to palpation without rebound tenderness or rigidity. His blood glucose level was 993 mg/dL, and his anion gap was 36 mmol/L.
Computed tomography showed new severe gastric distention a scan 11 months previously to look for renal stones had been normal . The patients presentation, physical examination, and laboratory and radiographic investigations narrowed the working diagnosis to gastric outlet obstruction or acute gastroparesis, but since CT showed no obstructing mass, the diagnosis of acute gastroparesis that coexisted with diabetic ketoacidosis was more likely.
It Aches When I Push On The Top Of My Stomach
Tenderness in the abdomen is often indicative of inflammation or other acute processes in one or more organs. The organs are arranged in a circular pattern around the delicate region. Acute processes refer to pressure that occurs suddenly as a result of anything. For instance, twisted or obstructed organs may result in point discomfort.
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/6diabetic Stomach Pain: All You Need To Know
Managing diabetes is not easy. You have to change your lifestyle to manage the condition along with taking the prescribed medications.
Diabetics may also notice some change in their gut or how their gastrointestinal tract feels, sounds and responds. In some cases, it can also cause stomach ache. Here is why diabetes can lead to stomach aches and how to treat it.
How Is Diabetic Stomach Managed
The management strategies for diabetic stomach are as follows:
Gut Check: How To Prevent Or Control Digestive Issues In Diabetes
But just because you have diabetes doesnt mean you have to resign yourself to digestive problems as well. To help keep your digestive system in working order, follow these tips:
Keep your blood sugar tightly controlled. Whether youre looking to prevent or control digestive problems when you have diabetes, it is most important to rigorously pay attention to control blood sugar and keep your A1C within a healthy range, Reynolds says. A1C elevation is directly proportional to the level at which esophageal function and gastric function is impaired, he says. Everyones A1C goal is different talk to your doctor to learn yours.
Choose a healthy diet low in sugar and refined carbs. A diet high in refined sugar can mess up the gut bacteria, Cline says. He recommends staying away from foods high in saturated fat and refined carbohydrates, such as white bread, pasta, and rice, as well as processed sweets and snacks, like refined pastries and granola bars.
Research also suggests eating a healthy diet could help minimize disease progression, which is associated with neuropathy. A study published in April 2017 in the journal Nature, for instance, found that a certain substance produced by gut microbes is associated with a reduced likelihood of progression of type 2 diabetes in overweight people with prediabetes. That substance, indolepropionic acid, is linked with dietary fiber intake, the authors noted.
How Is Gastroparesis Diagnosed
Your doctor will go over your symptoms and medical history with you. He or she will also give you a physical examination and may order certain blood tests, including blood sugar levels.
Other tests that are used to diagnose gastroparesis include:
- Four-hour solid gastric emptying study: This is a test to determine the time is takes a meal to move through a your stomach. A technologist will take you to a room and give you a meal to eat that is tagged with a radioactive isotope. After you eat this meal, a one-minute image of your stomach will be taken. You will be allowed to leave the department, but you must return in one, two and four hours.
- SmartPill: This is a capsule that contains a small electronic device. You swallow the capsule, and as it moves through your digestive tract, it sends information to a receiver you are wearing on how quickly food is traveling through the digestive tract.
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Stomach Pain In Diabetics: Causes And Treatments
Many stomach aches result from temporary gastrointestinal issues which are soon resolved. However, stomach pain may be a sign of a more serious problem such as diabetic gastroparesis which is a result of delayed bowel movement. This inability of the stomach to empty normally leads to a stomach ache referred to as diabetes stomach pain. The condition usually occurs in individuals with diabetes type 1 although it can also affect those with type 2 diabetes. But what are the characteristics of gastroparesis and how is it treated?
What Causes Discomfort And Bloating In The Lower Abdomen
Abdominal bloating and lower abdominal discomfort may be exacerbated by swallowing too much air, eating high-fat meals that delay stomach emptying, and even worry. Constipation is one of the intestinal and stomach-related disorders that may produce these symptoms. an allergy to a particular substance, such as lactose or gluten.
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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.
Diabetes Stomach Pain: The Mechanism
Although diabetes stomach pain occurs in both types of diabetes, it is common in type-2 Diabetes. It can result from various causes. However, the primary reason for abdominal or stomach pain in diabetes is food retention in the stomach.
Diabetic involvement can damage the vagus nerve, a nerve linked with the control of stomach emptying. The process is known as diabetic neuropathy. In addition, it leads to gastroparesis, a condition that delays digestion and food retention in your stomach for an abnormally long duration. The condition causes abdominal pain, bloating, feeling of fullness even with comparatively less food intake. The most common symptom is heartburn. However, other symptoms like vomiting, undigested foods and fluctuation in blood glucose levels may also occur.
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What Affects The Microbiome Composition
This is still being reviewed but here are some of the common causes of microbiome problems:
- Past and present diet. Diets that lack diversity lack adequate fruits and vegetables and lack high fiber whole grains. Drinking too much alcohol. Eating refined sugars and processed foods. Refined sugar and processed foods increase inflammation and encourages yeast formation in the gut. Artificial sweeteners are questionable and some believe ingesting them may cause bacteria growth that triggers fat storage.
- Antibiotics are needed to kill bad bacteria, but they can also wipe out good bacteria and wreck your microbiome leading to bad bacteria overgrowth.
- Steroids/NSAIDS . These medications may be needed for inflammation and pain relief but in high doses can cause stomach lining disruption and irritation producing stomach lesions which ultimately change your microbiome.
- Lack of physical activity
- Smoking cigarettes
- Too much stress. Stress increases secretion of cortisol, reduces oxygen flow to the gut and changes gut bacteria.
- Lack of sleep. Both the quantity and quality of your sleep may change in Circadian rhythm which can disrupt gut bacteria.
Diabetes Symptoms And Diagnosis
The most common symptoms of any type of diabetes are extreme thirst and frequent urination, increased appetite, fatigue or exhaustion, dry skin, and vision changes . In more severe cases, symptoms can include unexplained weight loss or gain, slow-healing injuries, frequent illness or infections , and pain or numbness in the hands or feet. Long-term complications of diabetes can include kidney disease, cardiovascular disease, vision loss, and lower limb amputation.4 Those with type 2 diabetes might not experience any symptoms at first, or just one symptom, such as feeling slightly thirstier than previously. Type 1 diabetes tends to be more severe, especially in young children, who can experience weight loss and failure to thrive.
Your physician will order blood tests to assess fasting glucose as well as your average glucose levels over the last two to three months and, depending on your results, will determine whether you have normal levels, prediabetes, or some form of diabetes.
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Does Diabetes Cause Bloating
Having diabetes does not automatically mean that you will have bloating. However, diabetes that is not well managed can, over time, lead to a condition called gastroparesis. Gastroparesis is caused by nerve damage from high blood sugars, causing the muscles in the digestive tract to slow down or even not work at all. This results in food being digested much more slowly than usual. This, in turn, can affect your blood sugars. Symptoms of gastroparesis include bloating, cramping, heartburn, nausea, vomiting, and poor appetite. If you think you might have gastroparesis, talk with your health care provider about your symptoms and treatment options. Gastroparesis cant be cured, but it can be managed.
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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Introduction To Diabetic Gastroparesis
Gastroparesis is defined as delayed gastric emptying in the absence of mechanical outlet obstruction from the stomach the typical symptoms are early satiety, upper abdominal bloating, nausea and vomiting, and abdominal pain. In diabetes patients, abdominal fullness and bloating are associated with delayed emptying, but in general, abnormal gastric emptying is weakly associated with symptoms. Two other pathophysiological mechanisms may result in postprandial symptoms: accelerated emptying in the first hour and reduced fasting and postprandial gastric volumes ., All three factors have each been reported in one-third to one-half of patients with diabetic gastropathy and postprandial symptoms. The pathophysiology includes reduced fundic tone, suppression of antral contractions, impaired coordination of antroduodenal pressures, and stimulation of pyloric contractions. The basis for these abnormal functions is impaired glycemic control, extrinsic neuropathy, intrinsic neuropathy, disorders of the pacemaker cells called interstitial cells of Cajal, and, possibly, myopathy.
Other Tests That May Prove Helpful Diagnostically
The previous section detailed the diagnostic evaluations that typically may be performed to assess each of the potential GI complications of diabetes. The following text discusses additional testing that may be considered for patients unresponsive to appropriate therapy or for whom alternate rare diagnoses are possibilities.
Antroduodenal manometry uses a catheter to record phasic contractions in the antrum and proximal small bowel. Normal recordings show normal migrating motor complex activity, an organized pattern that clears the upper gut of undigested debris, and a contractile response to meals or motor stimulating medications. Abnormalities that may be detected include pylorospasm , visceral neuropathy , visceral myopathy , and rumination .
Electrogastrography is rarely performed to assess for abnormal cycling of the gastric electrical pacemaker that controls normal propagation of contractions in the distal stomach. This involves placing electrodes on the skin overlying the stomach and recording activity during fasting and after a meal. Normal EGG tracings show uniform electrical oscillations with a frequency of 3 cycles per minute that increase in amplitude with eating. Patients with gastroparesis may have cycling that is too fast or too slow or waveforms that do not increase in amplitude after a meal.
Small Intestinal Bacterial Overgrowth
Miscellaneous GI Complications of Diabetes
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