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Diabetic Gastroparesis

What is diabetic gastroparesis?

Diabetic gastroparesis is a type of nerve damage that slows digestion. High blood sugar levels from diabetes damage nerves and tissues in your stomach. The damage prevents your stomach from emptying normally. Gastroparesis is also called delayed gastric emptying.

What increases my risk of diabetic gastroparesis?

  • You have had type 1 or type 2 diabetes for at least 10 years.

  • You have eye, nerve, or kidney problems due to diabetes.

  • You are a woman.

What are the signs and symptoms of diabetic gastroparesis?

Your symptoms may be made worse if you take certain medicines, drink alcohol, or smoke cigarettes.

  • High or low blood sugar levels that you cannot control

  • Nausea, vomiting, or loss of appetite

  • Weight loss that you cannot control

  • Heartburn

  • Bloated or early full feeling while you eat

  • Sudden cramps, swelling, or pain in your abdomen

How is diabetic gastroparesis diagnosed?

Your healthcare provider will feel your abdomen. He will ask about your history of diabetes. He may ask if you have had surgery on your abdomen, or if your stomach feels full or tight. He may also ask if you have a history of kidney, nerve, or eye problems from diabetes. You may need any of the following tests:

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • Upper GI x-rays: During an upper GI series, an x-ray machine is used to take pictures of your stomach and intestines (bowel). You may be given a chalky liquid to drink before the pictures are taken. This liquid helps your stomach and intestines show up better on the x-rays. An upper GI series can show if you have an ulcer, a blocked intestine, or other problems.

  • Endoscopy: A scope is used to show images of the inside of your stomach. A scope is a long, bendable tube with a light on the end. A tiny camera may be hooked to the scope to take pictures. An endoscopy may show what is causing your digestive problems. Samples may be taken from your digestive tract and sent to a lab for tests.

  • Scintigraphy: This is also called a radioisotope gastric-emptying scan. Scintigraphy measures how quickly food moves out of your stomach. A slightly radioactive substance is placed in food. The amount of radiation is small and safe. You will eat the food and then lie under a machine that takes pictures of the food inside your stomach. Pictures will be taken every 15 minutes, up to 4 hours after you eat, or as directed.

  • Gastric manometry: This test is used to measure muscle movement in your stomach. Your healthcare provider will place a thin, flexible tube into your mouth and move it down into your stomach. The wire measures stomach activity, and shows if there are problems with digestion.

  • Ultrasound: This test uses sound waves to show pictures of different parts of your stomach as they are working.

Which medicines are used to treat diabetic gastroparesis?

Tell your healthcare provider about all the medicines you take. You may need to stop taking some medicines because they may slow your digestion. You may be given any of the following:

  • Insulin: You may need to start taking insulin or change the type of insulin you take to control your diabetes. You may also need to take your insulin more often than usual. If you normally take insulin before you eat, you may need to start taking it after instead. You may need an insulin pump if you continue to have unstable blood sugar levels. Ask your healthcare provider for more information about the insulin you may need.

  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.

  • Motility medicine: This medicine is given to help your stomach muscles move food and liquids out of your stomach faster. This medicine also may help you digest food better.

  • Erythromycin: This is an antibiotic that also improves stomach emptying.

Why may I need a feeding tube?

You may need a feeding tube if your stomach cannot process food at all. You may only need the feeding tube for a short time, until your stomach starts working again. You may need a long-term feeding tube if your gastroparesis is severe.

  • Nasal jejunal tube: This is also called an NJ tube. An NJ tube is a feeding tube that is passed through your nose and down to your stomach. This is a short-term treatment.

  • Jejunostomy tube: A jejunostomy tube (J-tube) is a small, flexible tube that is placed in your jejunum (small intestine). You may need this long-term treatment if your stomach cannot process food. The tube is used to give liquids, food, and medicine into your intestine instead of into your stomach. Your healthcare provider will place a J-tube through a small incision in your abdomen.

  • Gastric tube: You may need a gastric tube along with a J-tube. This may be done to release gas and relieve discomfort.

What can I do to manage diabetic gastroparesis?

  • Check your blood sugar level often: You may need to check your blood sugar level at least 3 times each day. High blood sugar levels slow your digestion and can make your gastroparesis worse. Ask your healthcare provider when and how often to check your blood sugar level.

  • Walk after you eat: This may help speed digestion.

  • Do not drink alcohol or smoke cigarettes: These may slow your digestion further.

What nutrition changes can I make to manage my symptoms?

Your healthcare provider or dietitian may give you a certain diet to help reduce your symptoms. The following guidelines can also help you manage your symptoms:

  • Eat less fat and fiber. High-fat and high-fiber foods may be hard for your stomach to digest.

  • Eat 4 to 6 small meals a day. Smaller, more frequent meals are easier for your stomach to handle.

  • Drink more liquids with your meals. Your healthcare provider may recommend liquid meals, such as soup. Liquid is easier to digest than solid food.

  • Ask if you should prepare your food in a blender. Blended foods are easier to digest. Ask for directions on which foods to use and how to blend the food correctly.

  • You may need to add vitamins to your food if your condition is severe or you are losing weight without trying. Ask for directions on which vitamins you may need and how to add them to your meals.

What are the risks of diabetic gastroparesis?

  • Slowed digestion may make your blood sugar levels hard to control. Your condition may worsen, and you may develop more severe symptoms. Bacteria can grow in food that stays in your stomach too long and make you ill. Food can also harden in your stomach if it sits too long, and cause blockages, vomiting, and nausea. Severe gastroparesis may lead to vomiting that impairs your daily life.

  • Slowed digestion and vomiting may also dehydrate you. This could decrease how much you urinate, and dry your skin and mucous cells. You may be admitted to a hospital if your vomiting does not stop, or you are severely dehydrated. gastroparesis may also damage your intestines. This may make it hard for your feeding tube to work. You may not get enough calories or vitamins if you cannot digest your food. Medicine used to treat diabetic gastroparesis may cause serious side effects, such as body shakes that you cannot control. Your risk for side effects increases if you are older than 65 or have therapy for more than 3 months.

When should I contact my healthcare provider?

  • Your blood sugar level is higher or lower than healthcare providers have told you it should be.

  • You continue to have pain and bloating in your abdomen.

  • You feel dizzy or weak.

  • You continue to have nausea and vomiting, or you are not able to eat.

  • You lose weight without trying.

  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You are vomiting more severely or for a longer period than usual.

  • You urinate less than normal, and your mouth is dry.

  • You have fainted.

  • You have severe pain in your stomach or abdomen.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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