Diabetes and digestive problems

Diabetes and your digestion

Diabetes can cause problems associated with digestion in your stomach as the result of a condition called gastroparesis. Literally, gastroparesis means “paralysis of the stomach,” but it is much more than that.

First, let’s understand how the stomach works. In the stomach, the stimulation of the vagus nerve causes contractions that help to crush food into small particles and mix it up with the acids and enzymes that break down food. The contractions of the stomach then propel the food out of the stomach a little at a time through a valve (pyloric sphincter) that opens into the small intestine. It may take up to 4 hours to empty food from the stomach into the intestine. A meal containing a high amount of fat slows down the process.

In people with diabetes, gastroparesis may be caused by damage of the vagus nerve when blood sugar has been high for a period of years. As a result of the damage, the food that enters the stomach is not pulverized and sits in the stomach for a longer period of time.

Gastroparesis symptoms can include bloating, abdominal pain, nausea, vomiting, a feeling of fullness soon after starting a meal, weight loss, and heartburn. Secretions of enzymes and acids from the stomach lining still occur, but they contribute to nausea and vomiting when the food hasn’t been crushed into small particles. If vomiting does occur, the food may come up in much the same condition as it went down.

Gastroparesis can create a vicious cycle in the control of blood sugar. Food that is not digested properly can make blood sugar difficult to control. In return, poor blood sugar control worsens gastroparesis by promoting slow stomach emptying. Therefore, blood sugar control plays an important role in preventing and managing gastroparesis.

The symptoms of gastroparesis can be improved by eating smaller, more frequent meals. Fibre may be a problem for people with gastroparesis because the stomach has problems breaking it down and it causes a feeling of fullness. Instead, people with gastroparesis may be advised to eat well-cooked fruits and vegetables, fish, chicken, yogurt, refined breads and grains, pureed and liquid foods, and to avoid fat.

Some medications may cause or worsen gastroparesis while others are used to treat the condition. Anyone with this condition should check with their physician or pharmacist about how their medications affect their digestion.

Diabetes damages the digestive system and can lead to a condition called Gastroparesis. Gastroparesis means the paralysis of your stomach.

Before you can understand how this condition develops, you first need to understand how the digestive system works. The digestive system comprises of a food tube (esophagus), a stomach and intestines which resemble pipe-lines.

The food we eat enters into our stomachs through the esophagus. Inside the stomach, the food gets partly digested. A valve-like structure at the end of the stomach called the pyloric sphincter allows the food in the stomach to then enter into the intestines.

Like all other parts of your body, your stomach receives signals from nerves. The nerve supplying the stomach is called the vagus nerve. The vagus nerve controls the movements of the stomach and allows the pyloric sphincter to relax.

When one has diabetes, it means they have uncontrolled levels of blood sugar. High blood sugar damages almost all the nerves in the body, including the vagus nerve too.

As a result, one can develop gastroparesis in which the stomach does not contract and pyloric sphincter does not relax to allow the food to enter into the intestines. This way, the food remains in the stomach for too long.

If you have gastroparesis, you may develop some or most of the following symptoms:

  • Nausea
  • Vomiting
  • Bloating
  • Pain in the stomach
  • Feeling of fullness
  • Heartburn

You can use the following precautions to control these symptoms:

  • Consult your doctor if you’re a person with diabetes and you’ve started to experience any of the above symptoms.
  • Eat smaller meals instead of bigger meals.
  • Try to eat 5-6 smaller meals a day instead of eating 2-3 bigger ones.
  • The fiber in your diet may complicate the symptoms. So you should avoid eating raw vegetables. Instead, cook your vegetables well before eating them.
  • Avoid fatty and fried foods.

The following food items may help improve your digestive symptoms:

  • Fish
  • Chicken
  • Yoghurt
  • White-bread

For the most part, the finding of delayed emptying provides a “marker” for a motor (motility) disturbance within the stomach. It may, or may not necessarily be the root cause of all your digestive symptoms; but it certainly plays an adverse role in affecting blood sugar control.

Further, gastroparesis – also know as delayed gastric emptying – is an old term that does not adequately describe all the motor problems that may occur in the diabetic stomach. Therefore, many doctors now call this condition: diabetic gastropathy. Again, gastro = stomach and pathy = disease. This term encompasses more unusual circumstances, as when the stomach may be emptying too rapidly.

Many children and adolescents with Type 1 diabetes suffer with delayed gastric emptying.

Delayed gastric emptying is not found exclusively in those individuals with long-standing diabetes. Gastroparesis can be evident early in the diagnosis of diabetes.

Various regions of the diabetic stomach may be affected or hampered. Individual differences will exist. Each section of the stomach has specific roles to perform for optimal motility. The normal stomach handles the emptying of solid and liquid foods differently. In the case of the diabetic stomach, while there may be a delay in emptying solids, usually the emptying of liquids is mostly preserved and not as adversely affected. Knowing this, one can maintain better control over widely fluctuating blood sugar levels by shifting one’s diet to include more liquid-meal substitutes.

What is rapid emptying of the stomach; or: dumping syndrome?
Rapid emptying of the stomach may produce symptoms similar to those found in gastroparesis, usually with an additional layer of symptoms – such as shakiness, excessive perspiration, light-headedness, rapid heart beat, and a feeling of lethargy – that are unrelated to the digestive tract. This problem of “dumping” from the stomach occurs very infrequently in Type 1 diabetics, but some evidence suggests that it is not uncommon in the early stages of Type 2 diabetes. And even more interestingly, for the Type 2 diabetic, the problem seems to be related to a rapid emptying of liquids and not to solid foods

What are the symptoms?
Generally, people who suffer from gastroparesis due to causes other than diabetes express their main symptoms as chronic nausea and vomiting. In the vast majority of diabetics however – especially in the earlier stages of diabetic gastroparesis – the characteristics of poor blood sugar control and acid reflux are often the signatures of delayed stomach emptying.

When gastroparesis becomes very advanced, symptoms become more pronounced. Furthermore, since many diabetics may also have sensory neuropathy, some of the uncomfortable symptoms of gastroparesis – like abdominal pain – are blunted to some extent, as in the case of silent MIs (heart attacks) in diabetics.

As mentioned, delayed gastric emptying also leads to frequent, and possibly severe, reflux or regurgitation of stomach contents into the mouth, causing a bad taste of stomach acid. Doctors refer to this as heartburn or GERD (gastro-esophageal reflux disease). Yet, frequently, it is delayed gastric emptying – the motor disturbance in the stomach – that leads to this problem. Reflux may also cause a hoarse voice and sore throat upon rising in the morning, recurrent sinus infections, or in more severe situations, pneumonia.

For the most severe forms of gastroparesis, bouts of nausea and vomiting may cycle in a pattern of flare-ups or may be a daily occurrence persisting for years. These unrelenting symptoms may cause emergency-room visits for rehydration and may lead to chronic malnutrition. There are approximately 1.6 million diabetics suffering with the more severe forms of gastroparesis.

Signs and symptoms include:

  • Wild swings in blood sugar levels, usually low at night and very high in the morning,

  • Vomiting of undigested food,

  • An early feeling of fullness when eating,

  • Nausea,

  • Abdominal bloating,

  • Constipation,

  • Difficulty swallowing,

  • Weight loss,

  • Heartburn/Esophageal reflux.

Dyspepsia or gastroparesis?
Both of these terms describe a problem of disrupted motility in the upper gut. Sorting out the terms can be difficult since they are subjective and describe the same collection of symptoms listed above. Some doctors reserve the term, dyspepsia, for less severe symptoms, while gastroparesis is used to describe more profound symptom intensity. Regardless, when structural problems and inflammation are not found in the upper gut, the driver for the symptoms is a motor disturbance (motility problem) due to disrupted/damaged nerve function within the stomach and small bowel.

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