Gastric emptying refers to your body’s ability to move food from your stomach to your small intestines. This process includes relaxation to accommodate food, contractions to aid in the movement of larger food particles and relaxation to allow food to exit the stomach. Long standing uncontrolled diabetes mellitus can impair this process. Over time, high blood sugar levels can have damaging effects on the nerves in our body, which includes the gastrointestinal tract. This can lead to complications, such as gastroparesis.
According to the American College of Gastroenterology (ACG), diabetes is the disease mostly associated with gastroparesis. The ACG estimates that 29% of people diagnosed with gastroparesis also have diabetes. Gastroparesis is a condition where the movement of food from the stomach to the small intestines is slowed or stopped. Patients with diabetic gastroparesis experience symptoms of feeling full quickly (referred to as satiety), nausea, bloating, and either constipation or diarrhea.
Consistently high blood sugars have a direct affect on normal stomach emptying. Therefore, people with diabetes should be extra particular about their blood sugar control. It is important to note that gastroparesis within itself will make it difficult to control sugar levels because of inconsistent food digestion rate. Prevention of gastroparesis goals are aimed at exceptional diabetes management and blood sugar control by making good lifestyle changes as well as optimal medication use if needed.
If you have gastroparesis, to decrease symptoms and improve quality of life, the American Diabetes Association (ADA) recommends several lifestyle modifications. Gastroparesis symptoms may improve with a low-fat and low-fiber diet, improved blood sugar control or medications. Fat and fiber increase the amount of time food stays in your stomach. Reducing fat and fiber consumption may aid in symptomatic control. The American College of Gastroenterology (ACG) recommends eating smaller more frequent meals (4-5 times per day) to reduce the amount of food the stomach is working on. The ACG also recommends increasing fluid intake. Gastric emptying of liquids is often normal in patients with delayed emptying for solids. High calorie liquids in small volumes can deliver nutrients efficiently. This may also help minimize unwanted symptoms. Carbonated beverages may worsen bloating and irritate the stomach. Consumption should be minimized. The ADA and ACG also recommend the use of medications in addition to proper eating habits if needed.
Prokinetic (pro-movement) medications cause your stomach to empty faster. The ADA guidelines recommend metoclopramide or erythromycin. Metoclopramide should be used at the lowest dose and for the shortest time necessary to minimize side effects. Using the liquid formulation may help both medications work faster. There are also medications available for nausea if needed. Patients with more severe symptoms such as uncontrollable vomiting and dehydration may require hospitalization. These patients may be appropriate candidates for more invasive treatments such as Botox injections, gastric electric stimulation, or surgical treatment.
By working with your health care provider to gain control of your diabetes and being mindful of your daily life choices you will be best equipped to prevent the onset of gastroparesis. If you are a patient with diabetes and have further questions or concerns about gastroparesis, please contact your provider today.
This Article is Brought to you By Our Guest Staff Writers:
Zaid Baara, PharmD Candidate 2017, MCPHS University
Jacob Oleck, PharmD Fellow, MCPHS University
Jennifer Goldman, PharmD, CDE, BC-ADM, FCCP
Professor of Pharmacy, MCPHS University Clinical Pharmacist, Well Life Medical.