When Diabetes Leads to a Lazy Stomach: The Goods on Gastroparesis

This article was originally published in Diabetes Health in October, 2007.

| Sep 22, 2008

Gastroparesis doesn't sound good, and it isn't. Literally "stomach paralysis," it is a form of diabetic neuropathy, or nerve damage, that is a common complication of diabetes. The damaged nerve in question is the vagus nerve, named for its vagabond-like wandering nature.

The vagus nerve meanders all the way from the brainstem to the colon, controlling heart rate, sweating, gastrointestinal contractions, and various other involuntary, automatic functions on its way. In the case of gastroparesis, it's the vagus nerve's control of stomach contractions that's damaged.

The stomach is basically a hollow ball made of muscle that serves as a storage container and mixing bowl for food. It's about the size of a small melon, but it can stretch to hold nearly a gallon if you really press the issue. In healthy people, wave-like contractions of the stomach, prompted by the vagus nerve, crush and churn your food into small particles and mix it up with enzymes and acids produced by the stomach's inner lining.

Then the stomach contractions, coming along in waves at about three per minute, slowly and evenly propel the pulverized food out through the pyloric valve, which opens just enough to release an eighth of an ounce of food at a time. From there it's down the small intestine, where the real nutrient absorption occurs. It can take four hours to empty your stomach into your small intestine, especially if you've eaten fat, which slows the process down.

If the vagus nerve has been damaged by years of high blood sugars, the process hits a snag. The walls of the stomach, paralyzed by the lack of vagus nerve stimulation, don't make their muscular wave-like contractions. As a result, food just sticks around in the stomach, unpulverized and going nowhere. It may sit and ferment, creating an environment that fosters the growth of harmful bacteria.

Alternatively, the food can harden into solid masses called bezoars (pronounced "bee's oars") that are similar to a cat's hairball. In olden days, bezoars were thought to be magical poison antidotes and were worth several times their weight in gold. These days, however, all they do is cause nausea and vomiting. Worst case scenario, they can even block the pyloric valve, creating a serious emergency.

The common symptoms of gastroparesis are bloating, abdominal pain, nausea, feeling full after just a few bites of a meal, weight loss, and heartburn. Nausea and vomiting generally occur many hours after the last meal, usually when your stomach is fullest from both food and the secretions stimulated by the food. Because the food hasn't been ground up during the interim, it often comes up in the same shape it went down in, so it is, unpleasantly enough, easily recognized.

Diabetes is the leading risk factor for gastroparesis. About one in five people with type 1 develop it, as well as many people with type 2. Once it develops, it makes blood sugar management even harder because erratic stomach emptying make blood sugar levels difficult to predict and control. Conversely, poor control of blood sugar levels makes gastroparesis worse by tending to slow gastric emptying.

There are any number of new methods to look for gastroparesis, many of which involve eating or drinking something rather unappetizing. In a gastric emptying study, considered one of the most accurate methods to diagnose gastroparesis, you must eat eggs or oatmeal containing a harmless radioactive substance that makes the food visible on a Geiger-counter-like scan. Less commonly, you might undergo a barium x-ray, in which you fast for twelve hours and then drink a sludgy liquid that coats the inside of your stomach and makes its contents visible on x-ray.

Other diagnostic tests involve threading a little tube down into your stomach to assess the strength, frequency, and coordination of your stomach contractions or the electrical signals that travel through your stomach and stimulate its contractions.

The simplest way to address gastroparesis is through dietary changes. Smaller, more frequent meals ameliorate that feeling of fullness and are faster and easier to digest than three big meals. If your appetite diminishes later in the day, eat more in the morning and stick to liquids in the afternoon. By lying on your right side after eating, you can put gravity to work to help empty your stomach.

A big problem is fiber, which helps things move along in the intestines but has the opposite effect in the stomach. The stomach has a hard time breaking down roughage, which is also more likely to sit around and form those unwanted bezoars. So people with gastroparesis are often advised to avoid raw vegetables and eat soft, low-fiber foods like well-cooked fruits and vegetables, fish, chicken, yogurt, refined breads and grains, or pureed or liquid foods.

Sometimes it's advisable to avoid fats, which slow down stomach emptying even in healthy people. If you're vomiting a lot, it's also important to drink water to avoid dehydration and to take supplements in liquid form. If you can't tolerate any food or liquid at all, your doctor might place a feeding tube in your small intestine to bypass your stomach altogether. It's usually a temporary fix, used only in severe cases or when blood sugar levels can't be controlled.

Sometimes gastroparesis can be worsened, or even caused, by medications that slow stomach emptying, including narcotic pain medications, tricyclic anti-depressants, and calcium channel blockers, as well as some blood pressure medications, lithium, and antacids that contain aluminum hydroxide.

Clonidine, dopamine agonists, and progesterone are also implicated. So if you have gastroparesis, your symptoms could improve if you move off those medications under the care of your doctor. Nicotine is also associated with impaired gastric emptying, so you might want to quit smoking.

Especially in people with diabetes, it's critical to regain control of blood sugar levels that are out of whack, especially because better control of blood sugar levels can actually improve stomach emptying. Sometimes it can help to take insulin after meals instead of before. Testing more frequently will allow you to take insulin in response to blood glucose levels as they rise, rather than in response to a meal that might just take awhile to hit the bloodstream. Your doctor can advise you about methods to bring your blood sugars down and, hopefully, relieve your gastroparesis.

There are a number of drugs available to treat gastroparesis: Some of them relieve nausea and vomiting; others ease abdominal pain. Others still, called pro-motility drugs, stimulate contractions of the stomach muscles. There's also the rather new possibility of getting a pacemaker for your stomach, which generates electrical pulses that stimulate the wave-like muscle contractions you need to get things moving again.

The latest (and still experimental) treatment is injection of botulinum toxin (Botox) into the pylorus; just like it does to your forehead wrinkles, the Botox temporarily relaxes the powerful pyloric muscle, thereby enlarging the outlet from the stomach to the intestine and allowing the release of more food.

Gastroparesis is not usually life-threatening, but it can really put a dent in your quality of life and make your diabetes much harder to control. There's been a lot of progress made recently in treatments for the condition, so think about taking a trip to your doctor or gastroenterologist. It just might get things moving along in the right direction.

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Categories: Blood Glucose, Blood Sugar, Diabetes, Diabetes, Diets, Food, Gastroparesis (Digestion Problems), Insulin, Type 1 Issues, Type 2 Issues


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Comments

Posted by Anonymous on 27 October 2007

i'm so sick of this. type 1 diabetes, high cholesterol, high triglycerides, hypertension, gastroparesis...and pre-existing condition clauses that make me want to shove my foot up someones colorectal cavity

Posted by Anonymous on 18 November 2007

I am 28 years old and have had type 1 diabetes for 21 years now. About 5 years ago, i developed gastroparesis, and just as the article suggests, it DOES put a huge dent in the quality of my life. This site is probably the best one i have come across......many helpful points. I ordered a book from America a few years ago about type 1 diabetes, written by a type 1 diabetic doctor, and it has a whole chapter on gastroparesis! It suggests to do certain exercises after you eat as well as avoiding caffeine and mint. And chewing EXTRA gum for about an hour after each meal!

Posted by Anonymous on 20 November 2007

This is a great article. I have had gastroparesis for 4 yrs. I do not have diabetes. I do take Domperidone and it helps. However, I still have to eat 6 small snacks a day. I am very concerned that I am eating the right foods. I take supplements. Is there anyone else out there that also has dermatitis herpetiformis? Eatin is the pits!

Posted by Anonymous on 7 December 2007

hi my husband has type 2 diabetes, he has cronic dioreah, will this stop we cant see an end to it, he is also impotent, we had 1 course of viagra 2 no avail so he will not now go back for help.will it end

Posted by Anonymous on 16 December 2007

hi my husband has type 2 diabetes, he has cronic dioreah, will this stop we cant see an end to it, he is also impotent, we had 1 course of viagra 2 no avail so he will not now go back for help.will it end
please reply

Posted by Anonymous on 9 January 2008

I am 53 and just diagnosed with gastroparesis a couple months ago...I had an EGD to check my esophagus and learned I have 4 ulcers, this is when they noticed the food still in my stomach. I did start eating smaller portions during the day, even eating lots of "soft" foods but the PA said she wanted me to eat what I had always eaten..well that isnt happening..I take the pill 30 mins before eating that is suppose to help the stomach contract, but its not helping..I still get nauseated sometimes, along with the full feeling after eating a little bit...I also have cardiomyopathy and my cardiologist just today told me to do stretches 3 times a day...does anyone know of any exercises or movements that help them? Thanks for any suggestions here and best of luck to everyone.

Posted by Anonymous on 31 January 2008

I am in agreement with most people that this is the BEST site for explaining gastroparesis. I do NOT have diabetes but have been diagnosed with this problem. My doctor tells me that there is nothing I can do except eat smaller meals more often during the day. It is disappointing to feel that there is NOTHING I can take for the disease, as my Dr. told me they took REGLAN off of the market. Is there any way to stimulate the stomach muscles/vagus nerve to improving the movement of food along to the intestines? I am willing to try anything. Do sit ups help at all? My Dr. has had me on PREVACID for a long time due to GERD. I was wondering if this slowed my stomach down?
Any suggestions would be welcome.

Posted by Anonymous on 20 February 2008

Hi, I'm a GI NP and REglan has not been taken off the market. I'd ask for a referral to a gastroenterologist who specializes in motility issues.

Posted by Anonymous on 2 May 2008

Excellent site, thankyou. Can anyone talk about the gastric pacemaker? I am interested in the device and it's success. I am Insulin dependent for 42 years. Had nausea for 20 years. Combination bowel problems,either all the time or not at all. Hope to have tests, but have tried all the pills! Would be more interested in the Gastric pacemaker, as have also tried small meals, liquids etc etc. I use a very low dose of insulin, swing more to hypos, but no perfect control......Cheers

Posted by Anonymous on 11 May 2008

Ok so i need help.. i WAS a type 2 diabetic untill recently. With a significant weight loss i have been taken off all diabetic medications and my blood sugar's are perfectly normal right now as is my insulin level. I was diagnose with a "lazy stomach" this past week. I have already tried domperidone which didn't work. My dr suggested elavil, but i'm already on that for my migraines. He then put me on xanax in hopes of that working. I'm getting horrible mood swings as well as other side effects from the xanax. Does anybody know of.. or has been on any other treatment for this??

Posted by Anonymous on 28 July 2008

Walking for half an hour everyday is very important.

Posted by chickadee410 on 23 September 2008

I have had Type 1 diabetes for 41 years, and some days I just want to scream. I have gastroparesis and neuropathy of the legs since 1984. I struggle constantly with too low and too high of BG's. This makes my complications worse. I don't eat foods that bother my stomach, and I can only eat 1/2 cup of food at a time. I check my BG every 3 hours even at night. It greatly affects my social life and work. But I keep hanging in there, and I have a wonderful Endocrinologist to help me.

Posted by Anonymous on 24 September 2008

Hi, have you ever herd of burning tongue sydrome and is it associated with type 2 diabetes? I have it for over 1 year and I think I also have lazy stomach too. I'm nauseated all the time, I have seen 7 dr's of all types and no one knows what this is. please help!

Posted by Anonymous on 30 September 2008

I have had gastropares for about 10 years now. I have great gastroenterologist. He tried me on Reglan that only worked for about a year or two. I am now on what they call zofran which chemo therapy patients use to help there nausea. I am also a type 2 diabetic. I have also had gastric by pass surgery to help me lose weight and hoping to get my sugars under control and was hoping the gastropares would go away but it has not. I was on insulin but I was taken off of it because of low blood sugar readings. The Zofran has a gerneric which works just as good. This medication is very expensive but if you have a health plan it will pay for most of it. I am still having problems keeping my sugars under control.

Posted by Anonymous on 3 October 2008

I dont have diabetes but have suffered with GP for 2yrs. I have tried reglan, gastric pacemaker, and other various meds. phernergan,zofran and rimmeron the newest study in Japan im told. Nothing has worked for very long not over a month. The pacemaker makes me more nauseous when its turned on. I am currently using medical marijuana to help with nauseua, vomiting, apppetite plus it helps relax me when i have diarrehea. I dont want to be "stoned" all the time but the alternative is worse imo. I didnt smoke cannabis until after i was sick for about a year. My uncle used it for nauseua, vomiting when he had cancer. It has been the only thing that has helped me. Besides yoga i do it at least 4x a week it helps me keep muscle and not overwork myself.

Posted by Anonymous on 11 November 2008

I was diagnosed as a type 1 diabetic nearly 34 years ago. 13 years ago I was positively diagnosed with gastroparesis. My board certified, Northwestern Univ. School of Med. Gradute doctor went the route of dietary review, with a dietician, meds, and I exercise and follow a tight schedule daily. The meds seemed useless. After learning about medical use marijuana, I tried that meathod of treatment. This treatment proved consistant beneficial results, and the added benefit of my glacoma reversing. Trouble is medical marijuana is not yet legal in Illinois - where I live. So aquiring it makes me very uneasy. Coincidently, my glucose levels are managed with ease. Sure hope Illinois changes their view on the current laws regarding medical use marijuana.

Posted by Anonymous on 6 February 2009

so basically, there's no cure..

Posted by Anonymous on 10 April 2009

Ihad the botox injections in my pyloric valve recently. This has taken the bloating and painfull full feeling away. My bloodsugars are wacky though...no fibre, and my tummy open leads to spiking sugars when I eat!! Anyone else out there had this procedure??

Posted by Anonymous on 25 April 2009

I have type 1 diabetes for 47 years and a recent diagnosis of gastroparesis, I am wondering if other diabetics using insulin pump and CGM technology have any suggestions for improved bg control.

Posted by Anonymous on 28 April 2009

Just diagnosed with severe gastroparesis. I am considered "pre diabetes" since my levels can be high but when specifically tested I have not reached the level of actual diagnosis. The gastroparesis is so difficult, I feel nauseated ALL the time, I can't eat much, but I never throw up, at least not yet. How many of you actually throw up? Is it common or it is more common to just feel super bloated and nauseated? Thanks.

Posted by Anonymous on 25 May 2009

To the person suffering with diareah, what diabetes medicine is he on? I was on Metformin & it caused severe diareah. He should review the side effects of his meds.

Posted by Anonymous on 16 June 2009

My BG was pre-diabetic at the end of October. Starting the first of November after taking a diabetes education class, I started following the low carbohydrate diet. A couple of days after starting the diet, I became severly constipated. Two weeks after starting the diet I had the first episode of severe epigastric pain and vomiting. The frequency of those episodes has now progressed until now it is every three days.

I'm convinced my digestive tract has been screwed up by following this low-carb diet. My BG since the initial test has been consistently right at 100 or below.

Did anyone else develop GP after following the low-carb diet? Once the doctors/dieticians have screwed up your system, does any diet change fix things? I've tried eating several small meals, I still vomit every few days. Nothing stops the pain. I hurt all the time.

Posted by Anonymous on 30 June 2009

This is a good site. Finally, I can piece my symptoms to what has been described to date. The best solution that would solve Blood Sugar spike and low and lazy stomach would help loosing weight. I started exercising but shedding the weight is very slow due to uneven blood sugar level and can't go on any strict diet due to most of these food like Fiber, Vege are not digesting well hence not much choice of food out there. I think I'll try vegetable soup ..at least get the vitamins and minerals without the fiber.

Posted by Anonymous on 19 December 2009

I have had type 1 diabetes for 41 years. I was diagnosed with gastroparesis using a stomach motility study. My stomach empties at half the rate it should. I was given Regaln for nauseau, but it unfortunately has a side effect of tardive dyskensia, which causes my tongue to twitch, protrude,swell, and cause some pain. I'm told it is not noticeable (thank God), but I can feel it all the time, and it does drive my crazy. This drug should be taken off the market!!
Anyway it try to eat light and often. My insulin intake is now way down because I was getting hypoglycemic when I didn't eat. I lost 50 pounds in 8 months without trying! I am currently taking liquid erythromyacin 200mg before a meal and it does help. I take Beneful for roughage, and whey protein powder to provide protein (can't meat anymore). My question is about domperidone. I have one gastroenterologist who says it doesn't have the same side effects as Reglan, and another that warns me that it DOES have the same side effects of Reglan. Does anybody know anymore about the side effects of domperidone? I don't want my TD to get any worse!

Posted by Anonymous on 12 March 2010

i think that gastroparesis can be quite serious as it makes it more difficult to control blood sugars

Posted by DanDare on 15 March 2010

Gastroparesis stikes me usually in the early hours when I wake up in pain, sweating and feeling nauseous. My stomach is as hard as a drum. In desperation one night I took some Lactulose solution that was prescribed for my wife's constipation. I don't suffer from constipation but found that the medication is brilliant for curing my Gastroparesis. I take six or eight teaspoonsfull and it starts to work in about one hour and in two hours I am almost fully recovered. I know when it starts to work because I hear the pyloric valve starting to empty my stomach. This works so well for me I wonder if anyone else has used it or if any doctors prescribe it specifically for this problem. I guess it works by softening the stomach contents.

Posted by Anonymous on 16 July 2011

Look at taking Organic Apple Cider Vinegar (with the mother--dark cloudy content), 1 tablespoon in a glass of water, before a meal. Natural way of adding acid to the stomach to help breakdown food along with other benefits. Can add a teaspoon of honey for taste if needed.Krogers carries in organic section for @ $6.00


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