- Type 1 Diabetes Mellitus in Children
- What is type 1 diabetes in children?
- What causes type 1 diabetes in a child?
- Which children are at risk for type 1 diabetes?
- What are the symptoms of type 1 diabetes in a child?
- How is type 1 diabetes diagnosed in a child?
- How is type 1 diabetes treated in a child?
- What are the possible complications of type 1 diabetes in a child?
- How can I help my child live with type 1 diabetes?
- When should I call my child’s healthcare provider?
- Key points about type 1 diabetes in children
- Next steps
- Sick Day Management Tips when Your Child Has Type 1 Diabetes
- Type 1 Diabetes and Gastroparesis
- Managing Diabetes During an Illness
- Diabetic Gastroparesis—Know the Symptoms and Your Treatment Options
- What is diabetic gastroparesis?
- The signs & symptoms of diabetic gastroparesis
- Complications of diabetic gastroparesis
- Diagnosing diabetic gastroparesis
- Treatment for diabetic gastroparesis
- Surgical treatment methods for severe diabetic gastroparesis
- Managing diabetes differently with gastroparesis
Type 1 Diabetes Mellitus in Children
What is type 1 diabetes in children?
Diabetes is a condition in which the body can’t make enough insulin, or can’t use insulin normally. Type 1 diabetes is an autoimmune disorder. The body’s immune system damages the cells in the pancreas that make insulin. Insulin is a hormone. It helps sugar (glucose) in the blood get into cells of the body to be used as fuel. When glucose can’t enter the cells, it builds up in the blood. This is called high blood sugar (hyperglycemia). High blood sugar can cause problems all over the body. It can damage blood vessels and nerves. It can harm the eyes, kidneys, and heart. It can also cause symptoms such as tiredness.
Type 1 diabetes mellitus is a long-term (chronic) condition. It may start at any age. Insulin from the pancreas must be replaced with insulin injections or an insulin pump.
There are two forms of type 1 diabetes:
- Immune-mediated diabetes. This is an autoimmune disorder in which the body’s immune system damages the cells in the pancreas that make insulin. This is the most common kind of type 1 diabetes.
- Idiopathic type 1. This refers to rare forms of the disease with no known cause.
What causes type 1 diabetes in a child?
The cause of type 1 diabetes is unknown. Researchers think some people inherit a gene than can cause type 1 diabetes if a trigger such as a virus occurs.
Which children are at risk for type 1 diabetes?
A child is more at risk for type 1 diabetes if he or she has any of these risk factors:
- A family member with the condition
- Caucasian race
- Being from Finland or Sardinia
- Is age 4 to 6, or 10 to 14
What are the symptoms of type 1 diabetes in a child?
Type 1 diabetes often appears suddenly. In children, type 1 diabetes symptoms may be like flu symptoms. Symptoms can occur a bit differently in each child. They can include:
- High levels of glucose in the blood and urine when tested
- Unusual thirst
- Frequent urination (a baby may need more diaper changes, or a toilet-trained child may start wetting his or her pants)
- Extreme hunger but weight loss
- Loss of appetite in younger children
- Blurred vision
- Nausea and vomiting
- Belly (abdominal) pain
- Weakness and fatigue
- Irritability and mood changes
- Serious diaper rash that does get better with treatment
- Fruity breath and fast breathing
- Yeast infection in girls
The symptoms of type 1 diabetes can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
How is type 1 diabetes diagnosed in a child?
The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam. Your child may also have blood tests, such as:
- Fasting plasma glucose. The blood is tested after at least 8 hours of not eating.
- Random plasma glucose. The blood is tested when there are symptoms of increased thirst, urination, and hunger.
How is type 1 diabetes treated in a child?
Children with type 1 diabetes must have daily injections of insulin to keep the blood glucose level within normal ranges. Insulin is given either by injection or insulin pump. Your child’s healthcare provider will show you how to give your child insulin with either method.
Treatment will also include:
- Eating the right foods to manage blood glucose levels. This includes timing meals and counting carbohydrates.
- Exercise, to lower blood sugar
- Regular blood testing to check blood-glucose levels
- Regular urine testing to check ketone levels
What are the possible complications of type 1 diabetes in a child?
Type 1 diabetes can cause:
- Ketoacidosis. This is when blood sugar levels are very high and the body starts making ketones. This is a very serious condition that needs to be treated right away in the hospital, sometimes in the intensive care unit. If your child is not treated right away, they are at risk for diabetic coma. A child with a diabetic coma loses consciousness because of brain swelling. The brain swells because of the very high blood sugar levels.
- Low blood sugar (hypoglycemia). This is also sometimes called an insulin reaction. This occurs when blood glucose drops too low.
Your child’s healthcare provider will tell you how to avoid these problems.
Over time, high blood sugar levels can damage blood vessels. Balancing insulin, diet, and activity can help keep blood sugar levels in the target range and help prevent complications such as:
- Eye problems
- Kidney disease
- Nerve damage
- Tooth and gum problems
- Skin and foot problems
- Heart and blood vessel disease
How can I help my child live with type 1 diabetes?
A type 1 diabetes diagnosis can be stressful for a child and his or her family. A younger child may not understand all the life changes, such as glucose monitoring and insulin injections. A child may feel:
- As if he or she is being punished
- Fearful of death
- Angry toward the parent
Parents can help their child by treating him or her as a normal child with diabetes management as just one aspect of their daily life.
Many areas have diabetes camps, support groups, and other organizations for children with type 1 diabetes and their families. Talk with your child’s healthcare provider for more information.
When should I call my child’s healthcare provider?
Call your child’s healthcare team if you need help. Also call the healthcare team if your child:
- Has new symptoms
- Often has high blood glucose levels
- Often has hypoglycemia
Key points about type 1 diabetes in children
- Type 1 diabetes mellitus is a long-term (chronic) condition. It may start at any age. Only 5% of people with diabetes have type 1.
- Type 1 diabetes is a condition in which blood glucose levels are abnormally high.
- It is most frequently caused by an autoimmune disorder in which the body’s immune system destroys the cells in the pancreas that produce insulin.
- Children with type 1 diabetes must have daily injections of insulin to keep the blood glucose level within normal ranges.
- Without insulin, blood glucose levels continue to rise and death will occur.
- With the administration of insulin, and other management activities, children with type 1 diabetes can lead active, healthy lives.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Sick Day Management Tips when Your Child Has Type 1 Diabetes
Having a sick child can be challenging—getting time off work and securing a last-minute doctor’s appointment isn’t always easy. But when your sick child also happens to have type 1 diabetes, it presents a separate set of complications relating to insulin and blood glucose (blood sugar) management. This article covers some important considerations to keep in mind the next time your child with type 1 diabetes feels under the weather.
Checking Blood Glucose and Ketones
Even the most common ailments, such as a cold or flu, can cause your child’s blood glucose levels to rise. Plus, some over-the-counter medications can cause blood glucose levels to increase even more.
Complicating matters, your child’s blood glucose levels may actually drop too low if he or she is vomiting or has stopped eating.
You just can’t be certain how an illness will affect your child’s blood glucose—that’s why it’s important to check their levels more often than you normally would. A general guideline to shoot for is to check their blood glucose every 2 to 3 hours, but remember—that’s a guideline. Your child may require more or fewer checks, depending on your health care professional’s recommendations.
In addition to checking blood glucose levels, you also need to check for the presence of ketones in the urine. In people with type 1 diabetes, common illnesses can lead to diabetic ketoacidosis, a condition characterized by acidic blood caused by the release of too many ketones.
Ketones are released when your body doesn’t have enough insulin, so it’s important to check your child’s urine regularly (usually every 4 hours) until there are no ketones detected. If ketones are still present, that’s a sign that your child needs more insulin. There are 2 ways to check ketones: using urine ketone strips or a meter that’s much like checking blood sugars but with a special test strip.
You can read more about ketoacidosis in our article about type 1 diabetes complications.
Insulin Adjustments During Sick Days
Oftentimes, your child may not want or be able to eat when sick. Even so, it’s still essential that your child keeps taking insulin when he or she is sick. Without insulin, the body will resort to burning fat for energy, and this can lead to diabetic ketoacidosis.
Because illness can wreak havoc on blood glucose levels, you will likely need to adjust your child’s insulin dosage. The degree of adjustment is completely unique to your child. Plus, the severity of the illness and treatments used also factor in (remember, some over-the-counter medications can affect your child’s blood glucose).
Use your child’s blood glucose levels as a guide when adjusting insulin. If you have any questions about how to adjust your child’s insulin on sick days, call your health care professional.
Food and Drink Guidelines
Certain nutritional considerations on sick days may help prevent potentially serious complications of type 1 diabetes. Make sure your child is drinking plenty of fluids, as this will prevent dehydration and ketoacidosis. As a general rule, your child should drink small amounts of liquids—about a ½ cup—every hour. It’s best for your child to drink slowly instead of in large gulps. Tea, broth, and of course, water, are ideal options.
If your child is unable to eat a normal meal, make sure he or she is taking in a certain amount of liquid or solid carbohydrates to prevent sudden drops in blood glucose. Fifteen grams of carbs every hour is a good amount to shoot for, but always follow the specific recommendations from your health care professional.
Below are some good examples of beverages and foods for sick days:
- Sugar-containing beverages (sugar-free liquids may be consumed if blood glucose levels are elevated)
- Fruit juice
- Sports drinks
- Broth-based soups
- Graham crackers
When to Seek Medical Attention
When your child has type 1 diabetes and is sick, there are a number of situations that warrant medical attention. If your child is having problems breathing and/or has had at least 3 episodes of vomiting or diarrhea within a single day, call your doctor. Also, if large amounts of ketones remain in your child’s urine after several hours, seek medical attention. Of course, if you have any questions or concerns about adjusting your child’s insulin dosage, don’t hesitate to call your health care professional.
Updated on: 10/28/14 Continue Reading Meal Planning for Children with Type 1 Diabetes View Sources
Type 1 Diabetes and Gastroparesis
Gastroparesis is a nerve disorder that affects the way food moves from the stomach through to the small intestine. Diabetes is the most common cause of gastroparesis. About 20 percent of people with type 1 diabetes will develop it.
“Gastroparesis means that there is nerve damage to a part or parts of the intestinal tract that are important in the movement of food through the gut as well as the absorption of food into the bloodstream,” says Jay Cohen, MD, medical director of the Endocrine Clinic, and clinical assistant professor of family medicine at the University of Tennessee.
While most people with type 1 diabetes won’t develop gastroparesis, says Dr. Cohen, if your blood glucose levels aren’t under good control, you are at an increased risk of this disorder.
How Gastroparesis Develops
Prolonged high blood glucose levels are thought to damage nerves and the blood vessels that supply them with nutrients and oxygen. These damaged nerves can include the vagus nerve, which controls the movement of food from your stomach into the rest of your digestive tract. When the vagus nerve is damaged, there is a delayed emptying of the stomach — food moves very slowly or can actually stop moving through the digestive tract.
“Managing blood sugars with gastroparesis is a big challenge,” says Cohen. “We usually expect food to be absorbed 15 to 20 minutes after you eat, but if the food is not moving in your gut and it is still in your stomach or a loop of the small intestine, you are at risk for low blood sugars,” he notes. “And then when the food does get absorbed several hours later, you have unexpected high blood sugars.”
Symptoms of gastroparesis include:
- Abdominal pain
- Vomiting undigested food
- Premature feeling of fullness
- Weight loss
- Problems with blood glucose control
- Decreased appetite
- Stomach spasms
These symptoms are often worse when you eat solid foods, high-fiber foods, high-fat foods, or carbonated drinks.
If you think you may have gastroparesis, it is important to talk with your doctor. Over time, gastroparesis can result in a bacterial infection of the stomach or hardened masses of food that obstruct the stomach.
Your medical team can diagnose gastroparesis by examining you, asking about your symptoms, and performing various tests, including:
- Barium X-ray. After not eating for 12 hours, you will drink barium, a thick liquid that will coat your stomach and allow it to show up on an X-ray. Usually, you won’t have any food left in your stomach after 12 hours. If you do, you probably have gastroparesis.
- Radioisotope gastric-emptying scan. You will eat something containing a radioisotope, which is slightly radioactive but not dangerous. Then you’ll be placed under a machine that can pick up the radioisotope. Doctors will look at a picture of the food in your stomach. If more than half of it is still in your stomach after two hours, you’ll probably be diagnosed with gastroparesis.
Gastroparesis is usually a chronic condition. The goal of gastroparesis treatment is to manage your symptoms, so treatment will be individualized and may include:
- Medications. Prokinetic medications such as metoclopramide (Reglan) and the antibiotic erythromycin can be used to stimulate stomach emptying and decrease nausea and vomiting.
- Diet. A special diet, which may consist of small, frequent meals or all liquids, can also help control gastroparesis.
- Artificial nutrition. In cases when you can’t eat, you may need a feeding tube that delivers nutrients and medications right into the bloodstream through a catheter, bypassing the stomach.
If you have gastroparesis and type 1 diabetes, you will need to work closely with your medical team to learn how to control your blood glucose levels by making changes in your diet, taking insulin more often or after you eat, and checking your blood glucose levels more frequently.
Managing Diabetes During an Illness
The golden rule is, even though you are ill … NEVER STOP YOUR INSULIN!
When the body is fighting illness it will cause the blood glucose levels to rise. This is due to the body’s defence mechanism for fighting illness and infection causing more glucose to be released into the bloodstream. This happens even if you are eating less than usual. Therefore when ill it is essential to manage your blood glucose levels as well as the illness.
Diabetic ketoacidosis (DKA) is a life threatening short-term complication of Type 1 Diabetes. Symptoms of DKA include excessive thirst, feeling nauseated or vomiting, tiredness and confusion, difficulty breathing, stomach pain, breath smelling of pear drops. If you have high blood glucose levels and signs of DKA seek medical advice immediately or go to the nearest emergency department for treatment.
At your Annual Review, get a copy of the sick day guidelines as they apply to YOUR diabetes,. Discuss with your diabetes team what to do in the event of illness, how to manage high blood glucose levels, when and how to test for ketones, when you should seek emergency assistance and who to contact if you need advice out of hours. Have a list of phone numbers for your diabetes team and out of hours GP in a convenient place.
In an emergency when you do not have your own sick day leaflet, download ‘General Sick Day Leaflet’ for general information on ketones, when to test, what they mean and how to avoid getting them. This information should be in addition to the individualised advice provided by your diabetes team.
Do not exercise if your blood glucose levels are very high and ketones are present, as with lack of insulin your glucose levels may rise further.
NB seek medical help if in ANY DOUBT or:
• Your glucose level remains high
• You have ketones in your urine or blood
• You are unable to eat
• You are vomiting or unable to keep down fluids
• Your temperature remains high
• Your glucose levels persist below 4mmol/l
Diabetic Gastroparesis—Know the Symptoms and Your Treatment Options
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 diabetes—both type 1 diabetes and type 2 diabetes. It’s even more common in individuals with both diabetes and obesity.1
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 you’ve been experiencing after you eat.
Diabetic Gastroparesis Causes Serious Abdominal Discomfort
It could be that you are one of the estimated 25-55% individuals with type 1 diabetics or the one-in-three people who have type 2 diabetes and experience symptoms of gastroparesis for which there isn’t yet an effective treatment targeted to improve this gastrointestinal condition.3
Let’s gain some perspective on the management of this gastrointestinal condition that’s further complicated by the presence of diabetes. Patients who sought out Mahdusudan Grover, MD, an assistant professor of medicine and a gastroenterologist at the Mayo Clinic in Rochester, Minnesota, hoping to gain relief from gastroparesis had only one option: metoclopramide (Reglan), the only drug approved to help patients with the condition but it comes with serious potential side effects and black box warnings.
Calling the situation “dark and bleak”—until now. New treatment options, including surgical and drug options are now becoming available with more therapeutic possibilities on the horizon, says Dr. Grover. Among the expanding therapies is a surgical procedure called G-POEM, or Gastro Peroral Endoscopic Myotomy.
Dr. Grover explains that the procedure involves removing a part of the stomach called the pylorus to help the stomach empty into the intestines more easily. Unfortunately, he says it’s too soon to know which patients may benefit the most by having the operation.
However, there is an endoscopic procedure, called EndoFLIP, which can determine if there is problem with the way the pylorus is working, and by gathering this information, it will narrow the possibility to those patients who clearly have poor pyloric function.
Currently, Dr. Grover estimates that 30 to 40% of patients with gastroparesis have something wrong with the pylorus. While there are no research in the United States available to confirm the prevalence of diabetes gastroparesis, there are several such studies underway in Europe that will begin to inform us of the frequency of this GI condition.
Another limitation to widespread adoption of the G-POEM is that there has been no research yet to compare the surgery to a “sham” procedure, says Michael Camilleri, MD, professor of medicine, pharmacology, and physiology, is also an endocrinologist at the Mayo Clinic in Rochester, which is needed to confirm that the benefits are real.
Still, Dr. Camilleri says that the surgery looks promising and is largely safe, making it an encouraging option for those whose Endo-FLIP examinations show some pyloric dysfunction.
Potential Drugs Offer Relief of Symptoms of Gastroparesis
There are also some medications that have been approved for other uses that doctors are increasingly trying in patients who have gastroparesis, says Dr. Grover. Aprepitant, for example, is approved to treat the nausea and vomiting that commonly arises following cancer chemotherapy.
This medication is one that he often considers prescribing to patients who are experiencing the bloating, abdominal pain and vomiting brought about from diabetic gastroparesis. However, it has had mixed results in reducing nausea.
“I tell my patients that aprepitant hasn’t been approved to treat their condition per se but that I have found it to improve similar symptoms in many other patients,” says Dr. Grover. Another drug, prucalopride, approved for constipation, seems to improve digestion. In the most recent study,5 prucalopride seems to have increased gastric motility, which accelerated gastric emptying. If this is confirmed in larger studies that are underway, this drug will be a game changer—so stay tuned.
Several new drugs are currently under investigation, says Dr. Camilleri, although the chance of approval is still years away. One is called velusetrag, and another is TAK-906. The former works in the same way as prucalopride while the latter may help lessen many of the symptoms of GI distress.
Other drugs include tradipitant, which may help with the stomach’s signaling ability, and relamorelin, which has been shown to improve symptoms like the abdominal pain and the nausea, but it also accelerates stomach emptying, which may not be beneficial.
Patients should ask their doctors about clinical trials to see if you are eligible to participate in those being done for gastroparesis,4 Dr. Grover says. This will give you a chance to receive treatment with one of the investigational drugs.
Managing Diabetes Lessen the Risk of Diabetic Gastroparesis
Many endocrinologists focus patient education to improve diabetic gastroparesis on managing blood sugar levels, says Dr. Camilleri. While there is some evidence that those whose poor glucose management and high hemoglobin A1c levels are more likely to end up in the hospital with gastroparesis, achieving good blood glucose is not a “miracle cure” he says.
Dr. Grover adds that better management of blood glucose may help some patients feel better. You may want to talk to your endocrinologist about using an insulin pump, which will continuously monitor your blood sugar and deliver insulin as needed. By allowing your blood sugar to be automated, you may find that you feel better in many ways, including improvements in the symptoms related to the diabetic gastroparesis.
There are some treatments for diabetes itself that can cause the stomach to empty more slowly, Dr. Camilleri says. These drugs end in “-tide,” like exenatide (Byetta)—a glucagon-like peptide-1 receptor agonist (GLP-1).
There are other good diabetes medications, such as the dipeptidyl peptidase 4 (DPP-4) inhibitors, or gliptins, but they don’t have as favorable an impact on gastric symptoms. When working with his diabetic patients who have gastroparesis, he makes a specific effort to be sure any medications given for blood sugar management won’t cause or worsen stomach problems.
Dietary Management Is Key to Improving GI Symptoms
For some individuals the easiest method for feeling better—a semi-liquid diet—can be hard to implement, says Dr. Grover. The way to reduce most of the unpleasant symptoms is to blend up solid food into a soft paste, which solves the problem of poor gastric emptying, but this is often unappealing and so not readily embraced.
Dr. Camilleri agrees liquids and blended solid foods are often much better tolerated but his patients find it distasteful. So he’ll often say, “Consider this: blending up a peanut butter sandwich is a better option than tube feeding,” which may happen if the symptoms get bad and last long enough. Often, individuals who are very rigorous with their diet are able to avoid the need for medications altogether,6 the doctors point out.
Many patients–about 80%–can avoid tube feeding by adjusting your diet to facilitate speedy gastric emptying.6 Dr. Camilleri says: “Gastroparesis is a chronic condition that will probably not go away but also isn’t likely to get worse.”
Be aware of the potential for nutrient deficiencies of some minerals, like copper and zinc,6 says Dr. Grover. This is more likely to occur when the condition has been present a long time. He also warns against any suggestion that you are a candidate for gastric bypass surgery or removing the stomach as a way to manage the symptoms. “This often replaces one problem with another,” he says.
Patients also need to stay well hydrated, particularly in the summer months or when the weather is warm, Dr. Grover adds. Some patients have symptoms whether they are eating or drinking. If you are having issues drinking, it’s better to have IV fluids than to risk dehydration.
“This condition isn’t transient,” Dr. Grover says. “Having diabetic gastroparesis is a chronic condition just as diabetes likely is, so you will want to learn to manage it for the long-term.”
Neither doctor has any financial conflicts regarding this discussion.
Updated on: 09/06/19 Continue Reading Metformin May Lessen Diabetes Complications, Improve Cognitive Decline View Sources
Diabetic gastroparesis can develop slowly, but eventually its symptoms become impossible to ignore as they will impact every part of your life.
It’s estimated that up to 50% of people living with diabetes develop some level of gastroparesis during their lifetime, but the symptoms can vary a lot from person to person and the condition is often not diagnosed correctly.
In this post, I will cover everything you need to know about diabetic gastroparesis: the symptoms, how it’s diagnosed, treatment options, daily management, and more. I will also share the best advice on dealing with diabetes gastroparesis from Laura, who lives with the condition, and Susan Weiner, the AADE Diabetes Educator of the Year.
Table of Contents
What is diabetic gastroparesis?
Gastroparesis is a known complication of type 1 and type 2 diabetes that impacts your body’s ability to properly digest food.
“Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines,” explains the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Diabetes-related gastroparesis usually develops because high blood sugar levels damage nerves throughout the entire body, including the vagus nerve which plays a significant role in the function of the digestive tract.
“High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves,” explains the American Diabetes Association (ADA).
The result is that your stomach muscles simply work poorly, or in more severe cases, they may not work at all. This means that your stomach will have a very hard time digesting the food you eat and moving it properly through the digestive system from the stomach to the small intestines to the large intestines and eventually through your colon and anus.
“If food stays too long in the stomach, it can cause problems like bacterial overgrowth because the food has fermented,” explains the ADA. “Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach.”
The larger those solid masses of undigested food are, the more likely they could block food from passing into the small intestine. This can become dangerous quickly if ignored or left untreated.
Gastroparesis in people with diabetes despite healthy blood sugar levels
While it’s usually associated with high blood sugar levels, diabetic gastroparesis can sometimes develop even if your HbA1c is in a healthy range and blood sugars are in your goal range.
Generally, a person who develops complications of diabetes despite healthy blood sugar levels will experience a combination of conditions rather than just one. For example: gastroparesis and retinopathy, or peripheral neuropathy and retinopathy.
The signs & symptoms of diabetic gastroparesis
The symptoms of gastroparesis are much more complicated than straight-forward digestion troubles. And like any complication in diabetes, it develops gradually which means the earlier signs and symptoms may go unnoticed until they are severe enough and genuinely disrupting your overall wellbeing. Here are a variety of symptoms and triggers for symptoms as reported by the ADA and the NIDDK.
Symptoms of diabetic gastroparesis
- Nausea after eating
- Vomiting after eating
- Fullness after eating only a small amount
- Mild to severe bloating after eating
- Mild to severe pain in the “epigastric” or upper section of your stomach after eating
- Gradual and unexplained weight-loss
- Lack of appetite
- Erratic blood sugar levels after eating despite finely-tuned insulin doses
- Heartburn or acid reflux
- Frequent burping
- Impaired oral drug absorption
- Spasms and cramping of the stomach wall
“It’s really important to discuss any distinct stomach or digestion issues with your healthcare team,” says Susan Weiner, MS, RDN, CDE, CDN, FAADE and 2015 AADE Diabetes Educator of the Year. “This may include chronic constipation, bloating, and recent spikes in your blood sugar levels that you don’t understand or can’t explain with the usual everyday challenges of diabetes management.”
Weiner notes that she would hope any healthcare professional would create an open and non-judgmental environment for their patients because this can be a very uncomfortable situation for people with diabetes. Struggling with blood sugar management comes with its own inevitable layer of guilt and frustration, which means you need a healthcare team that can support you properly through a potential gastroparesis diagnosis.
Things that worsen symptoms of gastroparesis
- High-fiber foods
- High-fat foods
- Large meals
- Stress, anxiety or depression
- Smoking cigarettes
- Carbonated beverages (soda, seltzer, etc.)
Medications that can worsen symptoms of gastroparesis
It’s important to review any medication you’re taking for other health conditions with your doctor because they may indirectly affect your digestive system and worsen your gastroparesis symptoms. Whenever discussing taking a new medication with any healthcare professional, be sure to explain that you have gastroparesis. Even medications used for your asthma and inhaler can impact your digestive tract!
- Narcotics (codeine, hydrocodone, morphine, oxycodone, tapentadol, etc.)
- Some antidepressants
- Some anticholinergics (medications designed to block nerve signals)
- Some medications used to treat an overactive bladder
- Symlin (a diabetes drug, also known as pramlintide)
Complications of diabetic gastroparesis
When your body isn’t able to properly digest food, a variety of complications can develop–even before you’ve been properly diagnosed with gastroparesis.
- Dehydration due to frequent vomiting
- Malnutrition due to poor absorption of nutrients in the food you eat
- Difficulty managing your blood sugar levels after eating
- Low-calorie intake or difficulty getting enough calories
- Bezoars (solid masses of undigested food in your stomach)
- Difficulty maintaining a healthy weight due to inability to eat enough
- Overall lower quality of life due to malnutrition and pain
Laura’s story – My first symptoms
“My first symptoms started six years prior to my diagnosis,” Laura Marie told Diabetes Strong. Laura has lived with type 1 diabetes since 2002, when she was 16 years old. Her diabetic gastroparesis diagnosis was in 2014.
“My symptoms of gastroparesis included nausea and vomiting, often feeling nauseous in the mornings and vomiting undigested food hours or ever even days after I’d eaten it.”
Laura says she had gradually become incredibly bloated. The bloating was severe enough that her clothing felt remarkably uncomfortable by the end of each day. And on top of bloating, she had started experiencing severe cramping and pain in her stomach.
“My blood sugar levels also proved to be very erratic–I would have a low blood sugar after eating, and a high blood sugar hours later, especially throughout the night.”
By eventually wearing a Continuous Glucose Monitor (CGM), Laura says she could see the full evidence of her erratic overnight blood sugars.
The scariest part of her symptoms, though, was the increasingly frequent visits to the Emergency Room for DKA (diabetic ketoacidosis). Laura says she was usually admitted to the hospital about every 6 months because her unmanageable blood sugars would lead to DKA.
“It was after being in DKA for what seemed like the hundredth time that I became so burnt-out, frustrated, and scared, that I told my healthcare professionals I was desperate for tests and a diagnosis.”
Unfortunately, Laura had suggested she be tested for diabetic gastroparesis in the past, but her doctor dismissed her, telling her she was “too young” to experience diabetes complications.
The bigger picture, however, showed that she easily qualified for gastroparesis testing because she already had autonomic neuropathy indicators as well.
Diagnosing diabetic gastroparesis
There are several ways to test for and officially diagnose diabetic gastroparesis. Before performing any complicated tests or procedures, your doctor will (and should) do a few very simple assessments of your overall health that can indicate a need for further.
These simple assessments include:
- Feeling your stomach for any tenderness, hardness, and pain
- Use a stethoscope to listen for any unusual sounds in your stomach
- Checking your blood pressure, temperature, and heart rate
- Looking for common signs of malnutrition and dehydration (which can include blood tests)
The next steps are to look at how quickly your stomach is able to digest food and empty that food into your intestines. The ADA and NIDDK list the following tests as the current methods of testing for and diagnosis gastroparesis:
You’ll be asked to fast (not eat) for 12 hours, then you’ll drink a not-so-tasty thick drink that contains barium. The barium essentially covers the inside of your stomach so it can be seen clearly on an X-ray. A healthy stomach will empty completely if it’s been at least 12 hours since eating food. If your X-ray still shows remnants or food, that is a very clear indication that your stomach is not digesting and emptying properly.
However, an empty stomach doesn’t necessarily mean you don’t have gastroparesis. If you and your healthcare team still suspect gastroparesis, you may be asked to repeat the entire test (including the fasting) a second time a few days later simply because your stomachs delayed emptying can vary from day-to-day.
Be warned, you may also be asked to eat something called “the barium beefsteak” which is an entire meal containing barium versus just a liquid. Since liquids digest fairly easily in people with gastroparesis, the “beefsteak” version of the barium can be more helpful in testing for and diagnosis the condition.
Radioisotope Gastric-Emptying Scan (aka: scintigraphy)
Another no-so-pleasant meal, this test involves eating a food or meal that contains something called a “radioisotope.” This radioactive substance shows up scans, and it’s not dangerous or harmful. After eating the radioactive meal, you’ll lie under a machine that identifies the radioisotopes in that food and your doctor will be able to see just how quickly that food is digested. If more than half of the radioactive food is still in your stomach after two hours, it’s clear that you have gastroparesis.
Gastric Emptying Breath Test
This not-so-normal meal will contain a substance that eventually makes its way into your intestines, which is then passed back into your breath. Your doctor will then get a sample of your breath about 4 hours after eating to see how much of the substance is still present. This will reveal how quickly or slowly your stomach is digesting and emptying its contents.
Gastric Manometry Test
You don’t have to eat anything too funky in this one. Instead, you’ll eat a normal meal as directed by your doctor, then (while you’re sedated) your doctor will pass a very thin tube down your throat and into your stomach. The wire within the tube will measure the muscular activity of your stomach as its try to digest any liquids or foods in your stomach. Any delayed digestion due to gastroparesis will show up on this test.
The “SmartPill” or Wireless Motility Capsule
No funky foods here either. Instead, it feels a little futuristic: you’ll swallow a small electronic device that gradually moves through your entire digestive tract! The capsule sends data to a device kept in your pocket and eventually, your doctor will review that data to see how quickly or slowly your entire digestive tract (including the intestines) was able to digest that electronic little pill. Eventually, you will “naturally pass” the little pill during your next trip to the bathroom.
Your doctor may also perform these tests to rule out other conditions
It’s important to be sure that your digestive symptoms aren’t the result of something else, so your doctor may also perform an ultrasound or endoscopy of your stomach.
- Upper Endoscopy: This test requires you to be sedated just like the gastric manometry test mentioned earlier. Then your doctor will pass a long, thin tube (the endoscope) down your throat and into your stomach to look for any signs of other problems.
- Ultrasound: An ultrasound is painless and non-invasive. You’ll simply lie on down in your doctor’s office with your belly exposed while they use a handheld scan (the same kind used on a pregnant woman’s belly) to rule out things like gallbladder disease or pancreatitis.
Treatment for diabetic gastroparesis
The first, and perhaps most challenging, aspect of treating and managing gastroparesis is what and how you eat. The NIDDK recommends the following guidelines to reduce your symptoms and overall discomfort:
- Eat a low-fiber diet
- Eat a low-fat diet
- Eat small meals (5 or 6 a day) instead of 2 or 3 larger meals
- Chew your food thoroughly and slowly
- Eat softer, well-cooked foods versus hard or raw foods
- Choose beverages that are not carbonated
- Limit or completely avoid alcohol
- Drink plenty of water
- Drink plenty of healthy fluids like low-fat broth
- Vegetable juices low in fiber, without added sugars
- Low-sugar sports drinks containing electrolytes
- Taking walks after meals
- Avoid lying down within 2 hours after eating
- Take a daily multivitamin, with a meal — suggest a “whole-food” based vitamin which is gentler on your stomach
You may find yourself thinking, “How on earth will I get enough healthy vegetables and fruit if I’m supposed to avoid fiber?” It’s inevitably going to be frustrating that the nutrition advice you’ve heard your entire adult life is now going to cause you pain if you follow it.
“Gastroparesis and diabetes can certainly make eating a healthy diet even more challenging,” says Weiner.
Weiner emphasizes the fact that every patient’s experience of gastroparesis is different, which means that while some of these guidelines may be right for you, others may not be necessary. It will take time to carefully figure out the right approach to nutrition for you.
There are a few details, though, that Weiner says seem to help nearly every patient.
“I’d definitely recommend learning how to eat slowly if you don’t already, and chew your food thoroughly and completely,” says Weiner.
The more you cook your vegetables–and avoid hard, crunchy vegetables–the happier your stomach will likely be. This means choices like carrots, for example, should definitely be eaten only when cooked, never raw.
“Drinking liquids can also be a problem because they fill up your stomach space quickly,” explains Weiner. “If you’re struggling with constipation, that means you already have limited capacity in your stomach for a nutritious meal. Instead, try to drink liquids between meals in order to stay hydrated, including veggie smoothies!”
In fact, investing in a decent quality smoothie is probably a good idea simply because it ensures those vegetables and fruits are already broken down to tiny pieces, making it far less work for your stomach to break down.
Medications to treat diabetic gastroparesis
Unfortunately, there’s no one clear medication treatment path that seems to help everyone. There’s a great deal of trial and error, and even when you find something that works, it may only help with your symptoms for a few days.
To read an extensive list of medications used to help patients with gastroparesis, visit this study from Sweden‘s Sahlgrenska University Hospital.
A medication available by phone/mail-order in Canada that several gastroparesis patients shared as being very helpful is “domperidone,” but for those in the US, you’ll need to call this recommended online Canadian pharmacy: 1-866-930-3784.
While Laura reports that this drug only helps her for a few days before she has to stop taking it due to the side-effects, other patients describe it as a “game-changer.”
Laura’s story – Managing my nutrition around gastroparesis
“In terms of my diet, I find this is still my biggest struggle,” says Laura. “At times, I can eat anything I like and have no issues at all with digestion. But other times, food greatly affects me and leaves me feeling lethargic, nauseous, in pain, and at times, depressed.”
Laura says that while she’s tried to find patterns in what does or doesn’t make her symptoms worse, she hasn’t come up with anything helpful.
“Fruit and veggies can be no issue for me one day, and a complete disaster the next,” explains Laura. “I have also noticed that the way I think about food has changed a lot since being diagnosed with gastroparesis.”
The challenges of the condition have caused Laura to avoid eating out at restaurants or going to many social gatherings because she’s never sure if she’ll find herself experiencing pain, nausea, and vomiting shortly after eating.
“I also skip meals if I’m feeling unwell, or even avoid eating all day from fear of the repercussions of eating something that may cause a flare-up,” she explains, and justifiably so.
During more severe or acute flare-ups, Laura says she inevitably eats very little food for several weeks until things settle down.
“My appetite disappears completely, and anything I do to try and eat causes me to feel nauseous during those acute periods. I lose a lot of weight and become very dehydrated in a short amount of time.”
The inconsistency and unpredictable nature of how your stomach will react to any type of food, let alone the common triggers, is without a doubt its greatest challenge and source of frustration.
Surgical treatment methods for severe diabetic gastroparesis
In severe cases, the NIDDK says alternative food-delivery methods become inevitable to ensure you’re getting adequate calories and nutrients. While the idea sounds overwhelming and scary, some of these options are far less invasive than others.
Feeding Tubes: Essentially, while sedated, a doctor will put a tube into your mouth or nose that extends all the way into your small intestine. You’ll be placed on a liquid diet, and the feeding tube will allow those calories and nutrients to go directing into your small intestine, completely skipping the area with the most trouble: your stomach.
There are two types of feeding tubes to discuss with your healthcare team:
- a traditional oral or nasal feeding tube (short-term)
- Jejunostomy feeding tube (long-term)
Intravenous Nutrition: The last method of delivering adequate calories and nutrients without involving your stomach, is called Parenteral nutrition. Essentially, it’s a short-term intravenous solution that delivers liquid nutrients and calories directly into your bloodstream.
Venting Gastrostomy: This gadget is designed to relieve pressure inside your stomach by creating a very small opening on the side of your abdominal wall and then into your stomach. A tube is then placed through this opening, allowing stomach contents to flow out of the tube and into an external device that you attach to the tube when you need to relieve severe stomach pain.
Gastric Electrical Stimulation (GES): Used only in diabetes-related gastroparesis, this is a small, battery-powered device that sends very small electrical pulses to the nerves and muscles in your lower stomach, encouraging it to move and thus digest the food sitting in your gut. It’s placed by a surgeon just beneath the skin on your lower abdomen with wires from the device attaching to the muscles of your stomach.
This method can be used as a long-term treatment to help with severe nausea and vomiting in patients for whom other medications or treatments aren’t effective.
Managing diabetes differently with gastroparesis
The trickiest part of managing your blood sugars with gastroparesis is that you’re never quite sure when the food you ate is going to be fully digested and make its way into your bloodstream, eventually raising your blood sugar.
You’ll find that some meals–or entire days–digest normally while other days the food you eat will digest unpredictably slowly, impacting your blood sugar in a way that feels nearly impossible to accurately time your insulin doses around.
One of the most helpful tools for learning when to safely administer insulin for your meals is going to be a continuous glucose monitor (CGM). A diagnosis of diabetic gastroparesis should absolutely qualify you for health insurance coverage, just make sure your doctor emphasizes this diagnosis in the paperwork.
Laura’s story – Managing my blood sugars around gastroparesis
The most common pattern of otherwise irrational blood sugar fluctuations Laura experiences as a result of her gastroparesis are severe low blood sugars after eating because the insulin dose kicked-in but the food she ate wasn’t being digested.
“Then it causes very high sugars hours later, which take a long time to come down, especially throughout the night.”
One tactic she’s developed to manage this is by using the “multiwave bolus” on her insulin pump for meals.
“I take an upfront amount of insulin before I eat, and then have the pump deliver the rest of the dose over the course of a few hours,” explains Laura. “Trying to estimate how many hours it will take for my food to digest is complete guesswork though, which is why I use a Freestyle Libre to track my blood sugars.”
While the Freestyle Libre isn’t a continuous glucose monitor like a DexCom or Medtronic CGM, it still provides instant data every time she swipes the device over the sensor site on her body.
“If I see a sharp rise in my blood sugar, then I take more insulin and try my best to monitor everything.”
The tricky part is trying to prevent the fast spikes by taking a correction dose for a rising blood sugar but then hoping it doesn’t start to come down too quickly. While this is a challenge anyone with type 1 diabetes has when juggling carbs and insulin and high blood sugars, the frequency and unpredictable cause of those rapidly-rising highs make this a much more daunting and exhausting challenge for those with gastroparesis.
“It’s an incredibly difficult balance act, which I feel, without a CGM or something like the Freestyle Libre, is impossible to manage.”
Laura’s advice to other patients struggling with gastroparesis
First and foremost, Laura says it’s crucial to make sure you’re researching the condition yourself (rather than only taking direction and education from your doctors), and make sure you’re 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 (and get a sign-up bonus) in the form below. We send out a weekly newsletter with the latest posts and recipes from Diabetes Strong.