Diabetic gastroparesis is one of the late complications of diabetes mellitus (diabetes). It is a dysfunction of gastric motility, which is manifested by bloating, nausea, and vomiting. The cause is damage to tiny nerve fibers caused by years of excessive blood sugar levels. One of the main problems of diabetic gastroparesis is that due to the gastric paralysis, the absorption of important diabetes medications is impeded at the same time.
What is diabetic gastroparesis?
Type II diabetes mellitus, often called diabetes for simplicity, is one of the major common ailments of our time and, along with hypertension, obesity and elevated blood lipid levels, is part of the so-called “metabolic syndrome” of the most common metabolic diseases of civilization. About nine percent of the population is already being treated for diabetes, and scientists expect this figure to double by 2030. The tricky thing about diabetes is that most of those affected do not even notice their metabolic disorder. It is only years later that secondary diseases disturb their well-being and lead them to the doctor. By then, however, it is often too late for the affected organ. It is therefore important to be aware of the late complications of diabetes mellitus and to take countermeasures at an early stage.
Causes
The cause of diabetic gastroparesis is the same as most other diabetic sequelae: Permanently elevated blood glucose levels in diabetics, especially if they are unaware of their condition and do not take medication for it, chronically and irrevocably damage the smallest blood vessels and nerve endings. So, in addition to the sensory disturbances of the feet from which many diabetics suffer, this also results, among other things, in “sensory disturbances of the stomach.” The stomach has many small sensors that signal to the central nervous system and its own mucosal cells when it is being filled, when it is being overstretched, when it needs more stomach acid, and so on. At the same time, the nervous system can send signals to the stomach to contract more strongly, preparing for an upcoming meal, for example, while the eater’s mouth is still watering. The importance of neurons for human digestion is thus multifaceted, and their failure manifests itself in a wide variety of ways.
Symptoms, complaints and signs
The main symptom of diabetic gastroparesis is gastrointestinal discomfort. Poor gastric emptying causes food to stay in the stomach too long, causing pain and bloating. Increased reflux symptoms may also occur. These general symptoms occur in most sufferers. They are usually accompanied by other gastrointestinal and cardiovascular complaints. Typically, constipation, diarrhea or fecal incontinence occur. Other symptoms depend on the cause of the discomfort. If diabetic gastroparesis is the result of permanently elevated blood glucose levels, it can also be accompanied by sensory disturbances in the limbs in addition to the aforementioned complaints of the gastrointestinal tract. The hands and feet are particularly affected, and in some cases they may tingle unpleasantly or even become paralyzed. Accompanying this, many diabetics experience tingling or burning of the feet or suffer from visual disturbances. Kidney dysfunction is also one of the typical concomitant diseases of diabetic gastroparesis. Most patients suffer from an increasing feeling of malaise as the disease progresses. This feeling of sickness usually persists for several weeks and can develop into a chronic condition if not treated. That is why, in the case of symptoms and complaints mentioned, the responsible physician should be consulted immediately.
Diagnosis and course
The main symptoms of diabetic gastroparesis are nausea and vomiting. Due to inadequate gastric emptying, food stays in the stomach longer than usual, feelings of satiety set in earlier, and there may also be feelings of fullness and increased reflux symptoms. Because these are such common symptoms, it is often difficult to attribute them to diabetes – nausea and vomiting also occur in large numbers in the healthy general population and are often not a cause for further concern.If other symptoms of diabetes occur at the same time, however, a doctor should definitely be consulted; a simple blood glucose test can already narrow down or rule out the cause. However, more than half of all diabetics, especially those with so-called “adult-onset diabetes” type II, complain of nausea, vomiting, diarrhea, constipation or fecal incontinence, which suggests an overall connection. It has not yet been possible to prove beyond doubt that there is a connection between the digestive complaints and the diabetes. There are sometimes quite complicated radiological or electrophysiological examination methods that can be used to prove the gastrointestinal motility disorder – however, the symptoms are usually sufficient if diabetes is known at the same time or can be newly proven. If a diabetic patient simultaneously experiences tingling or burning sensations in the feet (diabetic neuropathy), kidney dysfunction (diabetic nephropathy) or impaired vision (diabetic retinopathy), the presence of gastrointestinal symptoms is also most likely due to diabetic gastropathy. Gastroscopy can also be used to rule out other disorders of the stomach.
Complications
Common complications of diabetic gastroparesis include digestive problems affecting the upper part of the digestive system. Potential symptoms include vomiting and nausea in particular. If diabetic gastroparesis is not treated, these complications usually persist. Often, diabetic gastroparesis leads to a reduction in quality of life. Enjoyment of food may 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 diabetes, other medical complications are possible 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 when treated by a doctor, these complications and concomitant diseases are often overlooked. For example, diabetes can lead to various stress symptoms. In addition, diabetics suffer more often than average from schizophrenia (which is usually pre-existing) and/or anxiety disorders compared to the general population. This is especially true of generalized anxiety disorder. The link between type 2 diabetes and affective disorders goes both ways: people who suffer from diabetes have a higher risk of developing depression. Conversely, the presence of depression may promote the development of diabetes through various mechanisms (for example, stress eating, emotional eating attacks, purposeful self-harm, neglect of a balanced diet).
When should you see a doctor?
Diabetes mellitus patients who suddenly suffer from nausea and vomiting should consult a doctor. If tingling or burning of the feet or visual disturbance occurs at the same time, diabetic gastropathy may be the cause – in this case, the appropriate medical professional should be informed immediately. Even apparently healthy people should clarify these complaints, as they may be caused by a previously undetected diabetes. In the event of severe complications such as dehydration, circulatory collapse or kidney failure, the emergency physician must be called immediately. Accompanying first aid measures should be administered if necessary – i.e. mouth-to-mouth resuscitation or cardiac massage. Elderly diabetes patients are particularly susceptible to diabetic gastroparesis. The same applies to people who have had diabetes for many years and who have other medical conditions. Anyone who belongs to these risk groups should have the characteristic complaints clarified quickly and, if necessary, treated. In severe cases, this may require a longer stay in hospital. After initial treatment, close monitoring of the diabetes is recommended to rule out renewed complications and secondary diseases.
Treatment and therapy
To prevent the secondary diseases of diabetes, it is of utmost importance to achieve permanent blood glucose control. In this context, the earlier the diagnosis and the start of therapy, the fewer problems will occur later.If diabetic gastropathy is already present, it is still possible to cause a worsening and progression of the symptoms by adjusting the blood glucose. A major problem of gastropathy is that it simultaneously complicates the absorption of medications – diabetic tablets may lose their effect due to the long gastric resting time or slip through the intestine without being absorbed reasonably. This makes medical therapy more difficult and, in cases of doubt, leads to insulin having to be injected into the subcutis earlier than usual. Symptomatic against the gastric emptying disorder, so-called prokinetics can be tried beforehand, which stimulate gastrointestinal peristalsis. These include metoclopramide (MCP) and domperidone.
Outlook and prognosis
Diabetic gastroparesis, gastric paralysis due to damage to gastric nerves from elevated blood glucose levels, is often difficult to treat. However, the extent of the disorder varies among affected individuals. If the autonomic nerves in the area of the stomach are only slightly impaired, there are also only mild symptoms, which manifest themselves in a rapid feeling of satiety after eating even small amounts of food. In this case, a largely symptom-free state can even be achieved by changing the diet. In the case of more severe gastric paralysis, in addition to the feeling of fullness, there is often nausea, vomiting, dyspeptic complaints and, above all, hypoglycemic states. Prokinetic medications are used to try to improve gastric motility. This may relieve the symptoms. However, if the nerves are significantly damaged, this often does not work as well. Particularly severe forms of the disease often show complete resistance to drug therapies. In these cases, patients hope for the use of a gastric pacemaker, which can improve gastric motility by stimulating nerve impulses. However, even gastric pacemakers do not always help. Resection of the stomach then remains as the last therapeutic option. However, the success of this treatment method is very poorly proven and controversial. Severe complications may occur. Overall, the prognosis of diabetic gastroparesis, both with and without treatment, depends on the extent of nerve damage to the stomach.
Follow-up
In this disease, the measures and options for follow-up care are severely limited in most cases, so the affected person is primarily dependent on early detection and treatment of the disease. It can also not come to a self-healing, so that in the foreground of this disease is an early diagnosis to prevent further complications. In general, the person affected by this disease should pay attention to a healthy lifestyle with a balanced diet. Fatty or very sweet foods should be avoided in order not to put unnecessary strain on the stomach. Furthermore, sporting activities should also be carried out in order to counteract the symptoms. In many cases, the doctor can also help the person concerned to draw up a diet plan. Furthermore, regular checks and examinations by the doctor are also very useful. Since the disease is treated in some cases with the help of medications, the affected person should ensure that they are taken regularly and, above all, correctly. In case of any uncertainties or questions, a doctor should always be consulted first. With proper treatment, the life expectancy of the patient is not reduced by this disease.
What you can do yourself
Diabetic gastroparesis manifests itself in decreased peristalsis of the stomach and is one of the typical secondary diseases that the disease of diabetes mellitus can cause. It is mainly an unrecognized 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 acquired type 2 or the much rarer genetic type 1 diabetes. If diabetic gastroparesis has already set in, a number of self-help measures can be used to reduce the effects of the disease and make daily life more tolerable. Once diabetic gastroparesis has been diagnosed, the most important thing is to regularly check and adjust blood sugar. Likewise, blood pressure should be controlled and adjusted so that it is within the recommended normal range.The above measures help to slow down and even stop the progression of the disease. To keep the effects of gastroparesis as tolerable as possible, a switch from a few large meals to more frequent small snacks is recommended, because this facilitates the absorption of the nutrients they contain. Digestion is further aided by thorough chewing because enzymes contained in saliva already initiate breakdown of carbohydrates.