Ask The Expert
Complications

Gastroparesis, also called delayed stomach emptying or stomach paralysis, is a form of diabetic nerve damage that affects the stomach. This type of nerve damage, called autonomic neuropathy, affects the autonomic or involuntary nervous system that controls internal organs. The nerves in the stomach control the movement of food through the digestive tract, but in gastroparesis, the damaged nerves prevent food from passing through your stomach in the normal way and thus the food cannot be digested properly.

Normally your stomach provides slow, steady muscular contractions to break down the food into tiny particles; then the stomach pushes this "mulch" into your small bowel. With gastroparesis, this mechanism is reduced or lost, so the food stays in the stomach much longer than normal.

Common Symptoms: Note that many people experience no symptoms except for erratic blood glucose levels.

• Nausea
• Vomiting (This often occurs after a meal, but may include undigested food you ate 8-24 hours before, or you might vomit first thing in the morning even when you haven't eaten in several hours).
• Abdominal bloating
• Feeling full too quickly while eating
• Loss of appetite
• Heartburn and spitting up, because food and acid in the full stomach tend to move back up the esophagus
• Erratic blood glucose levels (Some people will have a low glucose during the meal, because as I explain it, you took your medication to lower your blood glucose but "the food hasn't left the building yet." In this situation, you have a mismatch of your food and insulin (or oral agent) since the medication is working but the glucose is not yet available from the stomach

Causes: Please refer to the question titled "Causes of Complications" below in the related questions section.

Diagnosis: Some doctors base their diagnosis and treatment solely on the symptoms. Others will evaluate it by x-rays and timed meal tests (measuring how long it takes your stomach to empty after a meal).

Treatment: Most importantly, your doctor would recommend the treatment appropriate for you. Below are some of the treatments used:

• Meticulous diabetes control: As with any diabetes complication, sometimes improving the glucose control will lessen the symptoms.
• Changing the time you take your diabetes medication: Often, fast onset, rapid-acting insulins (Humalog®, NovoLog®, or Apidra®) are used, and given after the meal rather than before the meal, since the food absorbs slowly and unpredictably. Some people are advised to test every 30 minutes after a meal and take their medication as soon as the glucose begins to rise-since with this condition, the glucose might not rise until a few hours after the meal.
• Various drugs: Certain drugs act to decrease nausea and increase the activity of the intestinal tract; examples of drugs used are: Reglan, Erythromycin, and others.
• Eating behaviors: Some recommend sitting upright while eating and for an hour after finishing a meal; chewing solid foods very thoroughly; using ground meats rather than non-ground cuts of meat.
• Eating small meals: Rather than a few large meals, spreading your meals throughout the day helps to prevent overfilling of the stomach.
• Cautious use of high-fiber or difficult-to-digest foods
• Avoiding fatty foods: Fat slows stomach emptying.
• Sometimes liquid food supplements are used.
• Surgery: In some circumstances, surgery is performed to bypass the stomach and insert a feeding tube.

As you can tell, this is a complicated disease that requires medical attention and individualized treatment. The course of this condition is difficult to predict, since some people have severe problems that require periodic hospitalization; others find that the symptoms disappear and reappear throughout their lives; yet others find that over time their condition seems to lessen and almost disappear.

If you think you have gastroparesis or you are already diagnosed, be sure to discuss this information with your doctor.