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Understanding Diabetic Gastroparesis

Gastroparesis is when food moves through the stomach more slowly than normal. It’s also called delayed gastric emptying. In someone with diabetes, it’s caused by damage to the vagus nerve. This damage is from ongoing (chronic) high blood sugar.

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What causes diabetic gastroparesis?

The vagus nerve helps control how food moves through the digestive system. This nerve can be damaged from chronic high blood sugar. Then food moves more slowly. Or it stops moving. Gastroparesis can also be caused by injury to the nerves and smooth muscle cells that line the stomach wall. These work to push the food along for digestion.

Symptoms of diabetic gastroparesis

Symptoms can include:

  • Nausea

  • Vomiting

  • Feeling full after eating a small amount of food

  • Belly pain or cramps

  • Heartburn

  • Belly bloating

  • Weight loss

  • Loss of appetite

  • High or low blood sugar levels

Diagnosing diabetic gastroparesis

Your healthcare provider will give you a physical exam and ask about your past health. You may have tests such as:

  • Blood tests. These tests check your levels of different blood cells. And they measure your chemical and mineral (electrolyte) levels.

  • Upper GI (gastrointestinal) series. This is also called a barium swallow. This test checks your food pipe (esophagus) and your stomach. It also looks at the first part of your small intestine (duodenum).

  • Radioisotope gastric-emptying scan. This test lets the doctor see food in your stomach during the scan. He or she can see how quickly food leaves your stomach.

  • Gastric manometry. This is also called antroduodenal manometry. This test checks the movement of muscles in your stomach and small intestine.

  • Upper endoscopy. This test looks at the inside of your esophagus, stomach, and duodenum.

  • Wireless capsule study. For this test, you swallow a small capsule that has a tiny camera. This test measures stomach emptying.

  • Scintigraphic gastric accommodation. This test measures your stomach contents before and after a meal. It also checks how well your stomach relaxes after you eat.

Treatment for diabetic gastroparesis

Your healthcare provider will create a care plan for you that may include:

  • Taking medicines. You may be prescribed medicine to help with blood sugar levels. Or to treat nausea and vomiting. Or to act on muscles in the digestive system. Your healthcare provider may prescribe a few medicines to see which ones work best.

  • Stopping some medicines. Your provider may tell you to stop taking any medicines that slow digestion.

  • Changing your diet. Making changes to your eating habits can help control the problem. (See "Changing your diet" below.)

  • Gastric neurotransmitter. This device may help control nausea and vomiting. It is put into your body by surgery.

  • Feeding by IV. In severe cases, you may need a feeding tube. This is also called parenteral nutrition. This is when nutrients are put right into your veins. A tube is put into one of your chest veins during a surgery. A bag with liquid nutrients or medicine is joined to the tube.

  • Surgery. In very severe cases, you may need surgery called a jejunostomy. A feeding tube is inserted through your belly into your small intestine. This tube lets nutrients go right into your small intestine instead of your stomach.

Changing your diet

These changes may help reduce the problem:

  • Eat 6 smaller meals a day instead of 3 large meals.

  • Have a few liquid meals a day instead of solid food. You may need to do this until your blood glucose levels are stable.

  • Don’t eat foods high in fat. This includes fried food, fatty meats, and high-fat dairy foods. These can slow your digestion.

  • Don’t eat foods high in insoluble fiber. This includes beans and many fruits and vegetables. These can be hard to digest. 

Talk with your healthcare provider or a dietitian about an eating plan that is best for you.

Possible complications of diabetic gastroparesis

Food that stays in the stomach for too long can cause problems. Food can ferment in the stomach. This can cause bacteria to grow. Undigested food can harden into a lump called a bezoar. This can cause nausea and vomiting. In some cases, it may block food from passing from the stomach to the small intestine. Gastroparesis can make it hard to manage blood sugar levels. It can also cause problems with vitamins and minerals being absorbed into the body. And it can make it hard to keep a healthy weight.

Living with diabetic gastroparesis

For many people, gastroparesis is a lifelong condition. With diabetes, the main goal is to control your blood sugar levels. Follow up with your healthcare provider as advised. You may need regular visits to manage your health.

When to call your healthcare provider

Call your healthcare provider if you have any of the following:

  • Severe belly pain

  • Can't keep down food or liquids

  • Weight loss

  • Other symptoms as advised by your healthcare provider

Online Medical Reviewer: Fetterman, Anne, RN, BSN
Online Medical Reviewer: Hurd, Robert, MD
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