DIABETIC GASTROPARESIS
·
Diabetic
gastroparesis, or delayed gastric emptying, is a medical condition caused by
partial paralysis of the stomach muscles.
·
It leads to food
remaining in the stomach for much longer than normal, and can occur in both
type 1 and type 2 diabetes.
·
It is more common
in type 1 diabetics, particularly those with poor glycemic control.
·
Normally, strong
muscular contractions squeeze the food down from the stomach into the small
intestine in peristaltic waves for further digestion.
·
Gastroparesis
occurs when the vagus nerve, which controls these contractions, is damaged,
affecting the contraction of the gastrointestinal muscles, and preventing the
stomach from emptying its content at a normal pace.
·
Diabetes can
damage the vagus nerve if blood glucose levels remain high over a prolonged
period.
SIGNS AND SYMPTOMS
·
Nausea
·
Vomiting of
undigested food
·
Early satiety and
lack of appetite
·
Heartburn
·
Abdominal
bloating
·
Pain in the upper
abdomen due to spasms of the stomach wall
·
Erratic blood
glucose levels
·
Weight loss
·
Consumption of
high-fibre, oily and spicy foods and carbonated drinks increase these symptoms.
COMPLICATIONS
·
General
malnutrition, chronic fatigue and weight loss because of poor calorie intake.
·
Bacterial
infection from the fermentation of undigested food.
·
Intestinal
obstruction due to solid masses of undigested food.
·
Fluctuations in
blood glucose levels because of delayed and unpredictable gastric emptying.
DIAGNOSIS AND MANAGEMENT
·
Evaluate any
gastrointestinal symptoms in diabetics to rule out gastroparesis.
·
Adequate glycemic
control remains the primary goal of treatment.
·
Appropriate
dosage and intake of diabetic medications, monitoring of food intake and blood
glucose levels are of utmost importance.
·
The mainstay of
medical treatment includes anti-emetic and pro-kinetic therapy.
·
Therapeutic
endoscopy may be beneficial in some cases.
·
For patients not
responding to medical therapy, there are other medical interventions possible.
SUGGESTIONS FOR DIETARY MODIFICATIONS
·
Eat smaller, but
more frequent meals.
·
Include low-fibre
diet.
·
Avoid tea,
coffee, alcohol, tobacco and chewing gum.
·
Avoid late
evening snacks.