Here’s another worst-case scenario
I’m a big fan of the digestive system.
— American author and illustrator David Macaulay
As I delve deeper into the scourge that is diabetes, it becomes clearer just how much harm it does to the body. There is hardly any part it cannot negatively affect, ranging from the nerves and the heart to the liver and the stomach.
Diabetes doesn’t have to be a death sentence, but many times it paves the way for damage in the body that can lead to amputation, strokes, heart attacks and, yes, even death.
I recently learned of gastroparesis, a disorder that affects people with Types 1 and 2 diabetes. According to the American Diabetes Association (diabetes.org), it’s when the stomach takes too long to empty its contents (delayed gastric emptying).
The website of the National Institutes of Health Genetic and Rare Diseases Information Center (rarediseases.info.nih. gov) says it’s that the muscles of the stomach just don’t work well.
The vagus nerve controls the movement of food through the digestive tract. It’s the longest cranial nerve, and it passes through the neck and goes all the way to the abdomen. If it is damaged or stops working, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.
Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High glucose causes chemical changes in nerves, and it damages the blood vessels that carry oxygen and nutrients to the nerves.
Signs and symptoms of gastroparesis are heartburn, nausea, an early feeling of fullness when eating, weight loss, bloating, erratic blood sugar levels, lack of appetite, reflux and stomach spasms.
Complications can include dehydration, electrolyte and blood sugar abnormalities, malnutrition, vitamin deficiencies and ulcers and metabolic bone disease.
Worst case scenario is a bezoar. It’s a solid mass of undigested food that gets stuck in the digestive track and forms a blockage.
Gastroparesis can make diabetes worse by making it more difficult to manage blood glucose levels. When food that has been taking its sweet time getting through the stomach finally enters the small intestine and is absorbed, glucose levels rise — again.
There are several ways the condition can be diagnosed:
Barium X-ray. After fasting for 12 hours, you drink a thick liquid containing the chemical element barium. It covers the inside of the stomach, making it show up on an X-ray. If the stomach still has food in it after those 12 fasting hours, gastroparesis is likely. If the stomach is empty but the doctor suspects you have delayed emptying, the test may be repeated.
Barium beefsteak meal. You eat a meal that contains barium, and the doctor watches as your stomach digests the meal. The amount of time it takes to digest gives the doctor an idea of how well the stomach is working.
Radioisotope gastric-emptying scan. You eat food that contains a slightly radioactive substance that shows an image of the food in the stomach when scanned, tracking how quickly it leaves the stomach.
Gastric manometry. The doctor passes a thin tube down the throat to the stomach. It contains a wire that takes measurements of the stomach’s electrical and muscular activity as it digests liquids and solid foods.
Blood tests. They are used to check blood counts and measure chemical and electrolyte levels.
The most important treatment for diabetes-related gastroparesis is to manage our blood glucose levels as well as possible. Treatment can include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes or intravenous feeding.
Changing eating habits can help manage symptoms, too. The doctor or a nutritionist can give advice to improve symptoms. It can be helpful to eat less foods at one time, to eat slowly, sit upright or take a walk after eating. Another option is avoiding high fat foods, which take longer to digest, and high-fiber foods, which can be difficult to digest.