Difficulty Controlling Blood Sugar? Consider Diabetic Gastroparesis

One disorder I see fairly frequently in the hospital is diabetic gastroparesis.  It’s a condition in which the stomach doesn’t empty its contents as quickly into the small intestine (duodenum) as it should.  The nerves that tell the stomach muscles to contract aren’t working properly.  It’s a type of neuropathy.

With gastroparesis, food absorption—including carbohydrates—is slower than usual.  Not only that, if you take pills to lower your sugar, their absorption into the blood stream will also be delayed.

As a result, blood sugars in affected type 1 and type 2 diabetics are difficult to control.  The expected rise in blood sugar after a carb-containing meal is difficult to predict—a major problem if you just injected a rapid-acting insulin!  Oral medication effects are also erratic. 

The frequency of diabetic gastroparesis is unclear.  No doubt it’s more common in people who’ve had diabetes for years, and in type 1 diabetics.

How Is Gastroparesis Diagnosed?

Other than erratic, unexplained poor blood sugar control, are there any other clues to diagnosis?  Symptoms suggestive of gastroparesis include early satiety, abdominal bloating, after-meal fullness, nausea, and vomiting.

The most common diagnostic test for gastroparesis is done at a radiology facility.  The patient eats a meal containing a radioactive chemical called (99m)technetium.  A special camera takes a picture of the stomach after two and four hours to see if the meal has moved on into the small intestine in a timely fashion.

What’s the Treatment for Gastroparesis?

Best to work with your personal physician on that.  It’s not real straightforward, but there is treatment involving meal composition and timing, timing of medications, and drugs to speed up stomach emptying.

Steve Parker, M.D.

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