Diabetic gastroparesis is a condition by which the food takes too long to empty from the stomach. It is a possible complication of diabetes, although other people can experience this condition without being diabetic. It's basically a type of neuropathy, otherwise known as nerve damage, which can also cause other secondary effects for diabetics.
The nerves damaged are the ones that control the automatic muscular activity of the stomach. This disrupts the normal emptying process, and the stomach ends up behaving like a floppy bag. Food is normally squeezed out of the stomach in a matter of hours, but when gastroparesis is present, stomach emptying is variable and food may even remain in the stomach for days. This condition can make it impossible to control diabetes, especially in diabetics who have an injection of insulin before each meal. Because the absorption of food is completely unpredictable, it is impossible to make the normal calculations about the type of food and the dose of insulin.
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Thankfully, most cases of gastroparesis can be treated using a combination of drugs, diet and insulin management. In rare cases, a feeding tube could be required. Antibiotics have been used with variable results. In recent years, specialists have treated gastroparesis by injecting botulinum toxin into the muscles at the outlet of the stomach. Early results of this procedure are promising.
Gastroparesis can come about in people who have Type 1 or Type 2 diabetes. When someone has this condition and eats a meal, their food seems to sit in their stomach for hours and hours. This is called delayed gastric emptying. The nerve that controls the movement of food through the digestive tract is called the vagus nerve. If it is damaged or doesn't work at all, the stomach muscles and intestines cannot properly move food along. This causes the food to be slowed or stopped along the way.
Diabetes can be the cause of damage to the vagus nerve just like it can cause other kinds of nerve damage throughout the body. Since the stomach cannot move the food along fast enough, this can lead to blood sugar levels that are high and out of control. The high blood sugar levels continuing throughout the body causes more chemical changes in the nerves. This in turn damages blood vessels that are carrying nutrients and oxygen to the nerves.
What are the symptoms of gastroparesis? They include things like:
- abdominal bloating,
- gastroesophageal reflux,
- weight loss,
- erratic blood sugar levels,
- throwing up undigested food,
- feeling full early when eating,
- stomach wall spasms, and
- lack of appetite.
Symptoms can be mild all the way through to severe, depending upon the person. There are several complications associated with gastroparesis including bacterial overgrowth since food sits in the system too long and has a chance to ferment. In addition, food can have time to harden into solid masses, called bezoars, which can obstruct the stomach. This is a very dangerous situation.
Gastroparesis can be diagnosed in several ways including:
- a barium x-ray,
- barium beefsteak meal, and
- a gastric emptying scan.
The doctor can also do something called gastric manometry which measures the electrical and muscular activity in your stomach. Blood tests can also be ordered, but they won't be conclusive for gastroparesis without other tests. Your doctor may also choose to do an ultrasound and/or an upper endoscopy to rule out other conditions.
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