Diabetes - The Medical Perspective
Diabetic neuropathy is a potential complication of diabetes. It is more common with individuals who have had diabetes for a number of years. Over time, elevated blood glucose levels can damage
nerves throughout your body. This is called neuropathy. There are several types of neuropathy. The neuropathy most commonly discussed is peripheral neuropathy, which causes pain, tingling,
numbness, and weakness in your hands and feet.
Autonomic neuropathy affects the nerves that control the bladder, intestinal tract and other organs. When elevated blood glucose levels affect the nerves that control digestion it
makes controlling blood glucose difficult and causes uncomfortable gastrointestinal symptoms. This form of autonomic neuropathy is known as gastroparesis. The vagus
nerve controls movement of food through the digestive tract. When the nerves controlling the muscles of the stomach are damaged the movement of food slows down or can even
Symptoms of gastroparesis will vary depending on the severity but may include the following:
- Alternating constipation and diarrhea
- Vomiting undigested food
- Abdominal bloating
- Feeling full even with a small intake of food
- Decreased appetite
- Erratic blood glucose levels
- Weight loss
- Stomach spasms
- Gastroesophageal reflux
Gastroparesis can make blood glucose control difficult. It is harder to predict the rise in glucose levels due to the slowed movement of food through the intestinal tract.
Your health care provider will order diagnostic tests if gastroparesis is suspected. Treatment may include changes in food choices and timing of insulin injections. Because of the
unpredictability of how food moves through the intestinal tract, you may need to take insulin more often or take it after eating a meal, rather than before. In addition to those changes, a
medication that speeds up the movement of food through the intestinal tract may also be prescribed. In severe cases, a feeding tube can be placed in the small intestine that bypasses the
stomach. Intravenous feedings are also an option when other treatments fail. Always consult with your healthcare provider for individualized diabetes care.
Diabetes and Food
Dietary modification can help decrease gastroparesis symptoms. Eating smaller, more frequent meals and sitting upright for at least one hour after eating may decrease symptoms. Chew foods well,
especially meats. Taking a walk after meals may also help empty the stomach. Other suggested changes are avoiding high fat and high fiber foods. Fat takes longer to be digested so eating
high-fat foods will only further slow digestion. This includes fatty meats, whole milk dairy products, butter, margarine, and oils. Choosing to bake, broil or grill your foods is always a
better option than frying. Fat in liquid form is sometimes better tolerated than fatty solid food.
Fiber is the part of foods that is not digested. Fruits, vegetables and whole grains are rich in fiber. Canned fruits, cooked vegetables and processed grains may be better choices. An
accumulation of undigested food and fiber can form into bezoars in the stomach. Bezoars can cause nausea, vomiting or an intestinal obstruction. Apples, berries, coconut, figs, oranges,
Brussels sprout, green beans legumes, potato peels and sauerkraut have been associated with bezoar formation in people with gastroparesis. A trial of blenderized or liquid foods may be better
tolerated than solid foods. To help maintain nutritional status, a low fiber, liquid nutrition supplement can be added.
When dietary modification and medication to speed up stomach emptying does not improve the symptoms of gastroparesis, a feeding tube or intravenous feedings may be necessary. A
gastroenterologist should be consulted for other treatment options.
Work with your healthcare provider and a registered dietitian to modify your diabetes meal plan and adjust fat and fiber content as appropriate to keep blood glucose levels controlled. Wide
swings in blood glucose control can make gastroparesis worse.