The diabetic gastroparesis is one of the late complications of diabetes mellitus (diabetes). It is a dysfunction of the stomach’s mobility, which manifests itself as a feeling of fullness, nausea and vomiting. The cause is damage to the smallest nerve fibers due to the excessive blood sugar level for years. One of the main problems with diabetic gastroparesis is that the stomach paralysis also hampers the absorption of important diabetes medication.
What is diabetic gastroparesis?
The type II diabetes mellitus, for simplicity often called diabetes, is one of the great nation suffering our times, and in addition high blood pressure, obesity and elevated blood lipid values part of the so called ” metabolic syndrome ” of the most common civilizational metabolic disorders.
Around nine percent of the population are already being treated for diabetes, and scientists expect this number to double by 2030. The tricky thing about diabetes is that most of those affected do not notice anything about their metabolic imbalance. Years later, secondary illnesses disrupt well-being and lead to a doctor. But then it is often too late for the affected organ. It is therefore important to know the late complications of diabetes mellitus and to take countermeasures at an early stage.
The cause of diabetic gastroparesis is the same as that of most other diabetic complications: through permanently high blood sugar levels in diabetics, especially if they do not know about their disease and are not taking any medication, the smallest blood vessels and nerve endings are chronically and irrevocably damaged.
In addition to the sensory disorders of the feet, from which many diabetics suffer, there are also “sensory disorders of the stomach”: The stomach has many small sensors that signal the central nervous system and its own mucous membrane cells when it is filled and when he gets overstretched, when he needs more stomach acid, and so on.
At the same time, the nervous system can send signals to the stomach to contract harder and, for example, to prepare for an upcoming meal while the person is eating while the mouth is still watering. The importance of nerve cells for human digestion is varied, and their failure manifests itself in a wide variety of ways.
Symptoms, ailments & signs
The main symptom of diabetic gastroparesis is gastrointestinal discomfort. The inadequate emptying of the stomach means that the food stays in the stomach too long, causing pain and feelings of fullness. Increased reflux symptoms can also occur. These general symptoms occur in most people affected.
They are usually accompanied by other complaints of the gastrointestinal tract and the cardiovascular system. Typically constipation, diarrhea, or fecal incontinence occurs. Other symptoms depend on the cause of the discomfort. If diabetic gastroparesis is the result of a permanently increased blood sugar level, the symptoms of the gastrointestinal tract mentioned can also lead to sensory disorders in the limbs.
The hands and feet are particularly affected, and in some cases they may have an uncomfortable tingling sensation or even be paralyzed. At the same time, many diabetics feel tingling or burning in their feet or suffer from visual disturbances. Kidney dysfunction is also one of the typical accompanying diseases of diabetic gastroparesis.
Most patients experience increasing malaise as the disease progresses. This feeling of illness usually persists for a few weeks and, if not treated, can develop into a chronic condition. That is why you should speak to the responsible doctor immediately in the event of the symptoms and complaints mentioned.
Diagnosis & course
The main symptoms of diabetic gastroparesis are nausea and vomiting. Due to the inadequate emptying of the stomach, the food stays in the stomach longer than usual, a feeling of satiety sets in earlier, a feeling of fullness and increased reflux symptoms can also occur.
Because these are so common symptoms, they are often difficult to attribute to diabetes – nausea and vomiting are common in the healthy general population and are often not a cause for further concern. If other symptoms of diabetes occur at the same time, a doctor should be consulted, a simple blood sugar test can narrow down or rule out the cause.
More than half of all diabetics, especially those of the so-called “old-age diabetes” type II, complain of nausea, vomiting, diarrhea, constipation or fecal incontinence, which suggests an overall connection.
The unequivocal proof of a connection between digestive problems and diabetes has not yet been possible. There are sometimes quite complicated radiological or electrophysiological examination methods with which one can detect the gastric and intestinal mobility disorders – however, the symptoms are usually sufficient if diabetes is known or can be newly detected at the same time.
If the diabetic experiences tingling or burning sensation in the feet (diabetic neuropathy), kidney dysfunction (diabetic nephropathy) or visual impairment (diabetic retinopathy), the presence of gastrointestinal symptoms is very likely to be due to diabetic gastropathy. Other gastric disorders can also be excluded by means of a gastroscopy.
Common complications of diabetic gastroparesis include digestive problems that affect the upper part of the digestive system. The main potential symptoms include vomiting and nausea. If diabetic gastroparesis is left untreated, these complications usually persist.
Diabetic gastroparesis often leads to a reduction in the quality of life. Food enjoyment can be impaired if meals are accompanied by nausea and vomiting. In addition, food plays an important role in cultural and social contexts.
Without treatment of the diabetes, further medical complications are possible, which can occur in addition to diabetic gastroparesis. These include, for example, wound healing disorders, neuropathy, diabetic foot syndrome or diabetic retinopathy (an eye disease).
In addition, diabetes can lead to psychological complications. Even with medical treatment, these complications and comorbidities are often overlooked. For example, diabetes can lead to various symptoms of stress. In addition, diabetics are more likely than the general population to suffer from schizophrenia (which is usually pre-existing) and / or anxiety disorders. This is especially true of generalized anxiety disorder.
The link between type 2 diabetes and mood disorders is possible in both directions: People who have diabetes are at higher risk of developing depression. Conversely, the presence of depression can promote the development of diabetes via various mechanisms (e.g. stress eating, emotional binge eating, targeted self-harm, neglect of a balanced diet).
When should you go to the doctor?
Diabetes mellitus patients who suddenly experience nausea and vomiting should consult a doctor. If there is tingling or burning sensation in the feet or a visual disturbance occurs at the same time, the cause may be diabetic gastropathy – in this case, the responsible doctor must be informed immediately. Apparently healthy people should also clarify the complaints mentioned, as this may be due to a previously undiscovered diabetes disease.
In the event of severe complications such as dehydration, circulatory collapse or kidney failure, the emergency doctor must be called immediately. In addition, if necessary, first aid measures must be provided – i.e. mouth-to-mouth resuscitation or chest compressions. Elderly diabetic patients are particularly prone to diabetic gastroparesis.
Likewise people who have been suffering from diabetes for many years and who have other diseases. Anyone who belongs to these risk groups should quickly clarify the characteristic complaints and, if necessary, have them treated. In severe cases, this requires a longer stay in the hospital. After the initial treatment, it is advisable to monitor diabetes closely in order to rule out further complications and secondary diseases.
Treatment & Therapy
To prevent the sequelae of diabetes, it is of the utmost importance to achieve a permanent control of the blood sugar. The following applies: the earlier the diagnosis and the start of therapy, the fewer problems arise later.
If diabetic gastropathy is already present, a worsening and progression of the symptoms can still be achieved by adjusting the blood sugar.
A major problem with gastropathy is that it also makes it difficult to absorb medication – diabetes tablets may lose their effectiveness due to the long gastric lying time or slide through the intestines without being properly absorbed. This makes medical therapy more difficult and, in case of doubt, means that insulin has to be injected into the subcutaneous tissue earlier than usual.
So-called prokinetics, which stimulate gastrointestinal peristalsis, can be tried beforehand as symptoms of the gastric emptying disorder. These include metoclopramide (MCP) and domperidone.
Outlook & forecast
Diabetic gastroparesis, i.e. stomach paralysis due to damage to gastric nerves due to increased blood sugar levels, is often difficult to treat. However, the extent of the disorder varies from person to person. If the autonomic nerves in the area of the stomach are only slightly impaired, only mild symptoms occur, which are expressed in a rapid feeling of satiety after eating even small amounts of food. By changing the diet, a largely symptom-free state can be achieved here.
In the case of severe gastric paralysis, in addition to a feeling of fullness, nausea, vomiting, dyspeptic complaints and, above all, hypoglycaemia occur. Prokinetic drugs are attempted to improve gastric mobility. This can help alleviate the symptoms.
However, when the nerves are severely damaged, it often doesn’t work so well. Particularly severe forms of the disease often show complete resistance to drug therapies. In these cases, the patient hopes to use a gastric pacemaker, which can improve gastric motility by stimulating nerve impulses. But even gastric pacemakers don’t always help.
Resection of the stomach is the last possible therapy option. However, the success of this treatment method is very poorly documented and controversial. Serious complications can arise. Overall, the prognosis of diabetic gastroparesis, both with and without treatment, depends on the extent of nerve damage in the stomach area.
With this disease, the measures and options for follow-up care are in most cases severely limited, so that the person affected is primarily dependent on early detection and treatment of the disease. Self-healing cannot occur either, so that the focus of this disease is on early diagnosis in order to prevent further complications.
In general, the sufferer with this disease should be aware of a healthy lifestyle with a balanced diet. Fatty or very sweet foods should be avoided in order not to burden the stomach unnecessarily. Sports activities should also be carried out to counteract the symptoms. In many cases, the doctor can also help the person make a nutrition plan.
Furthermore, regular checks and examinations by the doctor are very useful. Since the disease is treated with medication in some cases, the person affected should ensure that it is taken regularly and, above all, correctly. If anything is unclear or if you have any questions, you should always consult a doctor first. With proper treatment, this disease will not reduce the patient’s life expectancy.
You can do that yourself
Diabetic gastroparesis manifests itself in reduced peristalsis of the stomach and is one of the typical secondary diseases that diabetes mellitus can cause.
Above all, it is an undetected diabetes or a poorly adjusted and controlled blood sugar concentration that can lead to irreparable nerve damage (neuropathies) and vascular damage. The processes are independent of whether it is the acquired type 2 or the much rarer genetically determined type 1 of diabetes.
If diabetic gastroparesis has already set in, a number of self-help measures are suitable to reduce the effects of the disease and to make everyday life more bearable. After diagnosing diabetic gastroparesis, the most important thing is to check and adjust your blood sugar regularly. Blood pressure should also be checked and adjusted so that it is within the recommended normal range. The above measures help to slow down and even stop the course of the disease.
In order to keep the effects of gastroparesis as bearable as possible, it is recommended to switch from a few large meals to more frequent small snacks, as this makes it easier to absorb the nutrients they contain. Digestion is also supported by thorough chewing, because the enzymes contained in the saliva already initiate a breakdown of the carbohydrates.