Sugar Matters
March 6, 2009
Upsetting your Stomach-diabetes and the GI system Part 1

For those of you eating while you read this: you may want to stop, finish your food, then return to read. This week we start a two-part discussion about diabetes and its effects on your gastrointestinal system, specifically your stomach and your intestines. Let’s start with a few questions:{{more}}

1) Do you ever fill up faster than you thought you would while eating? For example, you put out your usual plate of food but get halfway through and you are already full?

2) Do you feel like throwing up after eating? Do you actually vomit?

3) Do you feel bloated after eating?

4) Are your blood sugars very erratic and difficult to predict even when you eat almost the same things everyday?

If you answered “yes” to one of more of those questions, you may have GASTROPARESIS, which is altered emptying of the stomach. See, I told you it would be better to finish eating before you read about this….

In a normal situation, the stomach contracts and moves in order to help digest and move the food along into the intestines. Without the stomach doing what it needs to do, food sits in the same place, thus making you still feel full even if you ate hours ago, and also making you feel like vomiting.

Our nervous system controls these necessary actions, so when diabetes affects your nerves your stomach is often affected as well. People who have other nerve damage from diabetes, for example numbness in their feet, are more likely to have this stomach problem. The longer you have had diabetes and the worse your blood sugars, the more likely you will develop gastroparesis.

In addition to the unpleasant aspects of feeling like you may vomit after eating (who wants THAT every time you eat?), having gastroparesis has serious impact on your diabetes management, especially for those of you using insulin. One of the major problems with gastroparesis is that the stomach does not empty in a predictable way or within a specific period of time. What happens then is that your digestion and rise in blood sugars also happen at unpredictable times, so your glucose can rise or fall at times you would not expect. As you can imagine, this can be a nightmare to treat, especially in people using insulin where you REALLY need the peak of insulin action to line up with the peak in glucose rise.

There are tests you can do to diagnose this condition with certainty, but most often the symptoms are fairly easy to recognize. Prevention is the best, of course, and keeping your blood sugars controlled is your best prevention from developing gastroparesis. I am sure you are not surprised by this information.

If you have already developed gastroparesis, you do need to keep working on your blood sugars because it can get somewhat better as your blood sugars improve. However, there are also medications that can be used to help your stomach empty at regular intervals. The two most commonly used are called Metoclopramide and Erythromycin.

All who want gastroparesis raise your hand! No takers? Hmm, I thought so. Remember: prevention, prevention, prevention is the best.

We’ll continue talking next week, still in the gut. Eat before you read…

Until next week, stay safe and healthy, Vincies!

Anita Ramsetty, MD
[email protected]
Medical Director Endocrine Care Group
Tel: 843-798-4227