Find us on Google+ Gastroparesis: Insight into Diabetic Gastroparesis from an Idiopathic Perspective

Wednesday, April 10, 2013

Insight into Diabetic Gastroparesis from an Idiopathic Perspective

I am not diabetic, although, I do become hypoglycemic occasionally. A friend and I were talking and we came to the conclusion that we should shed light on their condition in addition to idiopathic gastroparesis (GP). My friend (I am protecting her identity, not trying to deny her credit or anything), inspired this article and I just wanted to thank her for bringing it to my attention. All of the links are in bold, capital letters. If you click on them, they take you to the site they are referencing.

I wanted to provide some insight into DIABETIC GASTROPARESIS for those of us who are idiopathic.

I have asked the Diabetic GP Warriors on Facebook Pages, the SUPPORT FOR DIABETIC GP WARRIORS, and the DIGESTION DISORDERS FORUM on Facebook. I have cited people to the best of my ability without giving away personal information.



Image Taken from Flickr at: http://www.flickr.com/photos/capturelifeinaction/6880171870




These are different procedures that can be test regions of the gastrointestinal tract (GI), functional GI tests that are available locally, and their clinical utilities. The charts can be found below:



Images Taken From: http://media.oncologynurseadvisor.com/images/dsm/ch6560.table1.jpg





Let's start with what Diabetic Gastroparesis is.

The AMERICAN DIABETES ASSOCIATION has written this on the subject,

"Gastroparesis is a type of neuropathy (nerve damage) in which food is delayed from leaving the stomach. This nerve damage can be caused by long periods of high blood sugar.Delayed digestion makes the management of diabetes more difficult. It can be treated with insulin management, drugs, diet, or in severe cases, a feeding tube.

Gastroparesis is a disorder affecting people with both type 1 and type 2 diabetes in which the stomach takes too long to empty its contents (delayed gastric emptying). The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve 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 blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.
What are the symptoms?


Signs and symptoms of gastroparesis include the following:

Heartburn
Nausea
Vomiting of undigested food
Early feeling of fullness when eating
Weight loss
Abdominal bloating
Erratic blood glucose (sugar) levels
Lack of appetite
Gastroesophageal reflux
Spasms of the stomach wall


These symptoms may be mild or severe, depending on the person. No two people have gastroparesis are alike. This is part of the reason that is hard to diagnose because it mimics so many other symptoms.


ALSO, IF YOU DO NOT STOP YOUR PAIN MEDICATIONS OR OTHER MEDICATIONS AT LEAST A MONTH BEFORE YOUR GASTRIC EMPTYING SCAN, OR OTHER TESTING, YOUR TESTS COULD BE SKEWED AND YOU WILL NEED TO START ALL OVER AGAIN.

I'm very sorry about using all caps but I wanted to be sure and get that point across because not many doctors tell you about that.



What are the Complications?

Gastroparesis can make diabetes worse by making it more difficult to manage blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise.

If food stays too long in the stomach, it can cause problems like bacterial overgrowth because the food has fermented. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.



A bezoar in someone's hand.
Image courtesy of:
http://www.bezoarmustikapearls.com/images/dewa1thumb.JPG




Image Taken From Imgur:http://image.slidesharecdn.com/beatdiabetesvivalavive-160404084500/95/who-campaign-halt-the-rise-beat-diabetes-viva-la-vive-8-638.jpg?cb=1459877266



However, there are many ways to confirm a diagnosis of gastroparesis. The main issue is to find a good doctor who wil listen to you and try their best to help you and treat you with respect. The diagnosis of gastroparesis is confirmed through one or more of the following tests:




Barium X-ray

After fasting for 12 hours, you will drink a thick liquid containing barium, which covers the inside of the stomach, making it show up on the X-ray. Normally, the stomach will be empty of all food after 12 hours of fasting. If the X-ray shows food in the stomach, gastroparesis is likely. If the X-ray shows an empty stomach, but the doctor still suspects that you have delayed emptying, you may need to repeat the test another day. On any one day, a person with gastroparesis may digest a meal normally, giving a falsely normal test result. If you have diabetes, your doctor may have special instructions about fasting.


Image Found at: http://image.slidesharecdn.com/ca-imagingofstomach-141003080506-phpapp01/95/imaging-of-stomach-20-638.jpg?cb=1412323598




Barium Beefsteak Meal

You will eat a meal that contains barium, which allows the doctor to watch your stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working. This test can help find emptying problems that do not show up on the liquid barium X-ray. In fact, people who have diabetes-related gastroparesis often digest fluid normally, so the barium beefsteak meal can be more useful.


Image Taken From News Medical: http://www.news-medical.net/image.axd?picture=2013%2F8%2Fbarium+meal.jpg




Radioisotope Gastric-Emptying Scan

You will eat food that contains a radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radioisotope is small and not dangerous. After eating, you will lie under a machine that detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach. Gastroparesis is diagnosed if more than half of the food remains in the stomach after two hours.



Image Taken By Me at the Mayo Clinic:
http://4.bp.blogspot.com/-M6BgsRdQrX8/URFnNWyHMeI/AAAAAAAAYI0/DkTfoP_kFME/s1600/711571_10152526124110453_662203246_n.jpg




Image Taken From Radio-Pharmacy Inc.: http://files.ctctcdn.com/dc73e3db001/d91cbede-0467-4dc9-9e52-5fdad19c60eb.jpg




Gastric Manometry

This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the throat into the stomach. The tube contains a wire that takes measurements of the stomach's electrical and muscular activity as it digests liquids and solid food. The measurements show how the stomach is working and whether there is any delay in digestion.


Image Taken From The Cleveland Clinic: http://my.clevelandclinic.org/-/scassets/images/org/health/articles/4952-esoph-manometry.ashx




Image Taken From: http://www.ddri.ir/en/uploads/fmcontent/img/content_img_4ef2dce631220.jpg





Blood Tests

The doctor may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels.


Image Taken From: http://mediad.publicbroadcasting.net/p/wnpr/files/201403/Blood_sample_vial.jpg



To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound.




Upper Endoscopy

After giving you a sedative, the doctor passes a long, thin tube called an endoscope through the mouth and gently guides it down the esophagus into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.



Image Taken From: http://www.halstedsurgery.org/Upload/200802291526_08566_000.jpg




Ultrasound

To rule out gallbladder disease or pancreatitis as a source of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.



Image Taken From: http://www.thegpsurgery.co.uk/wp-content/uploads/2015/02/canstockphoto15515426-800x350.jpg





How is it Treated?

The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well as possible. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding.



Image Taken From: http://www.thegpsurgery.co.uk/wp-content/uploads/2015/02/canstockphoto15515426-800x350.jpg




Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To better manage blood glucose, you may need to consult with your doctor before trying the following:

*Take insulin more often
*Take your insulin after you eat instead of before
*Check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your doctor will give you specific instructions based on your particular needs.





Medication(s)

Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.



Image Taken By:http://s.doctoroz.com/styles/720x480/s3/sites/default/files/media/image_thumb/5-069-Weight-Gain-Medication-MEDIA-720.jpg?itok=oUL_ImLq




Meal and Food Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis has improved. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion — something you don't need if you have gastroparesis — and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.


Feeding Tube

If other approaches do not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. The feeding tube allows you to put nutrients directly into the small intestine, bypassing the stomach altogether. You will receive special liquid food to use with the tube. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream.

By avoiding the source of the problem (the stomach) and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe.

It is important to note that in most cases treatment does not cure gastroparesis — it is usually a chronic condition. Treatment helps you manage gastroparesis, so that you can be as healthy and comfortable as possible."



I work with other admins in different groups on Pinterest Boards, and we like to publish things from all over the Internet, everywhere between recipes (including juicing, smoothies, and gp friendly foods), and additionally post inspirational and motivational images to keep people fighting their illness. We don't want you to give up, EVER! If you *ever* need to talk to someone, find me on Facebook and we will talk over all of our options. Your life matters.




Image Taken From: http://www.aafp.org/afp/2013/0915/hi-res/afp20130915p371-t5.gif






I posed a series of questions to GP/DTP groups on Facebook and I received some amazing advice for those who are newly diagnosed with GP who may also have Diabetes. The questions I asked were:

Question 1: If you could give a tip to someone with diabetes who is newly diagnosed, what would it be?

Question 2: Please name one thing that you wish someone had told you about GP & Diabetes.

Question 3: Name things that help you cope through both conditions?

Question 4: What do you eat/do when you have low blood sugar with GP?

Question 5: What do you use as a source for Diabetic and GP safe recipes?

Question 6: Are you a Type 1 or a Type 2 Diabetic?


Here are the following answers that I have received. I hope they help those of you who have Diabetic Gastroparesis:


Kathleen writes,

"1. See endocrinologist asap after being diagnosed because you will most likely need to change how and when you dosage insulin to account for delay of food being digested.

2. Any diabetic can get GP. You can have a history of very well controlled diabetes, with A1C always under 7, as was the case with my daughter , and still get it. Her diagnosis was delayed because we were originally told that she couldn't possibly have GP because she hadn't had uncontrolled diabetes for a long time.

3. Humor and hope [check out the page I admin that has motivational pictures and humor. It's called LAUGHING THRU GP. *Emily*] You have to be able to laugh at some of the things we go through and always have hope that things will get better or that you can get through each obstacle that comes your way.

4. Apple juice works best for us. I am also a Type 1 Diabetic.”



Christine writes, “I walk every day.

2. Diet to combine the two.

3. Small and healthy meals combining 2 diseases and exercise.

4. Glucerna .

5. Difficult one but I use vegetables that I am allowed to enjoy along with chicken and fish.

6. I am also a type 2 diabetic.”



Diane writes,

“Question 1: If you could give a tip to someone with diabetes who is newly diagnosed, what would it be?
Read Labels. You would believe some of the stuff that has sugar in it.

Question 2: Please name one thing that you wish someone had told you about GP & Diabetes.
One thing is that you could get GP because of diabetes. Never heard of this kind of neuropathy until I got it.

Question 3: Name things that help you cope through both conditions?
Don't beat your self up for things you "used" could do.

Question 4: What do you eat/do when you have low blood sugar with GP?
Milk or Orange Juice [as a side note, OJ is very acidic and could lead to a GP attack - apple juice is safer *Emily*]

Question 5: What do you use as a source for Diabetic and GP safe recipes?
http://www.dlife.com.”


Claudia writes,

“#1 To believe in yourself, educate yourself, don't think the doctors are in control of your body, you are.

#2 I can't think of one thing for Type1, but I wish someone had explained to me that with GP it affects each person differently... same condition, different methods or treatments for each.

#3 Friends that are understanding and non-judging, hard to find, not many out there, but hold onto the TRUE ones.

#4 100% Juice saves me from lows when I am fighting with GP.

#5 I do not cook, I just steer clear of a lot of fiber and solid food... seems safer to me than to battle the moments afterwards."


Jason writes, “I do not have either diabetes nor GP but my father does and we have been through hell and back trying to get it under control. Through my experience I can recommend to people experiencing these ailments is to be proactive. I watch the doctors sit on there hands while my dad lost 50 lbs in 3 months on top of numerous sugar crashes and vomiting spells. Going to the er at least once a week with them just sending him home after his sugar leveled or he stopped the vomit/diarrhea spell. The doctors wrote my dad off basically and if it wasn't for us looking up stuff on our own and trying to convince the doctors to try things that they didn't think of, and believe me this is no small tasks when you have doctors that know everything, they told us "he's a very sick man" something we already knew and wanted to try and fix this to the best we could. Finally the doctor listened and they put him on tpn to help him get some weight back and also an anti depressant ( I can't remember the name) but its been known to help people with gp because it acts on the same neuroreceptors that anti nausea medicine does and also stimulates appetite. He then since has gotten a stimulator put in that is connected to his stomach and it seems to be helpful. I'm still learning myself on diabetics and gp. All I can recommend is to be proactive. Don't wait until it gets so bad like it did with my father. If you're not getting anywhere with your doctor find a new one. There is a lot of information online that we found helpful also.”


Janet writes, “Before I had my pancreas transplant, I had GP for about the last 5 years of my 26 year type 1 diabetes run. Type 1 diabetes and GP together is a bitch (excuse the language but it the mildest I can use to describe it). It is patly what put me in kidney failure. It makes it unbelievably hard to control your blood sugar, which of course causes further GP damage as well as damage to every other system in your body (nerves, blood vessels, eyes, heart, and on and on). As far as your questions:

1) Keep the best control of your blood sugars you can for exactly the reasons I stated above! I ended up in end stage kidney failure, on dialysis and getting a kidney and pancreas transplant by the time I was 33! The worse the GP gets, the harder the blood sugars get to control, even on an insulin pump. I could ho from 500s to 40s in less than half an hour.

2) When I was first diagnosed, I wish they had told me GP existed. Although at age 6, I'm sure they told my parents, bit not me as I would never comprehend it. Nor do I know if they were even aware of GP in the early 1980s.

3) To cope, I involved myself in the things I enjoy doing - spending time with my husband, playing with my dogs, sewing, crafting, gardening, etc. Of course, I was still working at the time (although that stopped when I went into kidney failure). I also saw (still do) a clinical psychologist (deals specifically with patients with chronic medical issues) and a psychiatrist, which helps tremendously.

4) When I had low blood sugar, I would treat with either juice (no oj though) or let chocolate melt in my mouth.

5) As gar as diet, no one ever suggested a special diet to me, so I no suggestions. All they ever did was try to treat me with meds.

Feel free to ask me more if you like. And I don't mind if you use my name. I am all about spreading awareness of diabetes, GP, kidney disease and organ donation. If my responses seem a little disconnected, please excuse me. I've been in the hospital almost nonstop since last Monday due to GP and the flu! And I'm still here!”


Arizona writes, " I use glucose tabs to bring my sugar up and if its really low I take a glucagon shot. I usually run super high during my period when my stomach freezes completely. Check your sugar as often as possible and take insulin more often. And after meals instead of before. Diabetes and GP can give you a run for your money. I wish my dx doctor would have told me to make a lifestyle change. He told me I could eat a cake for breakfast as long as I took insulin. What kind of doctor does that?"


Tina writes,

"#1-That gp & diabetes do exist. Start a diabetic diet. Learn to read labels & try to get as close to zero down the line in the fat, sugar, carbohydrates, & sodium categories. Cut out all fat, sugar, sodium, carbohydrates, gluten, etc. If one cooking oil says 50% fat & the other says 25% then purchase the 25% cooking oil. Cook w/cooking spray. Use spray butter. Although more expensive your systems will thank you later.

#2-It's okay to eat light soups, shakes, smoothies, or blender meals as your meal for management of diabetes & gastroparesis.

#3-Being able to say NO when others think you should be eating @ the all you can eat buffet! A good blender is probably the #1 thing needed for management of gastroparesis. A good heating pad, bed, pillows, loose fitting clothes, etc. Having understanding people in my life has been a really big help.

#4-I eat a yogurt smoothie, raisins, squash smoothie soup, broccoli smoothie soup, a half an apple w/a tablespoon of peanut butter & a tablespoon of marshmallow crème mixed together for a light dip, a cup of cantaloupe & strawberries blended into a smoothie, a few chips w/ranch yogurt dip, a watermelon smoothie, some raw fresh fruits & vegetables, guacamole & a few chips, beans (1/2 cup) & a few chips, a rice crispie treat, etc. I guess you really have to eat the minimum but several (6) times or more per day, not all @ once.

#5-Less is more. Replace all ingredients high in fat & sugar in recipes w/fat free & sugar free items. It’s more expensive but will be better on your systems in the long run. Eat foods easily digested & more fresh fruits & vegetables. Eat less or no meat because it's hard to digest. Don't eat anything white because it is high in sugar, bread, potatoes, rice, pasta, etc. Eat a small meal, wait 30 minutes, & you will feel full as your blood sugar rises. When you get hungry that is when your blood sugar has dropped. It's important to eat alittle something during this time as opposed to waiting 8 hours before eating. Dangerous! Another reason to always carry hard candy in your pockets. Anyway, I could probably write a book on these subjects, lol. Sorry for the brief synopsis. Hope it helps someone out there!"


Pauline writes, "I'm not a diabetic but would like to add something. I use ginger to treat my gastroparesis as it stimulates gastric motility. Ginger wouldn't be advised in the majority of diabetics since it speeds a meal hitting the bloodstream. When gastroparesis is a factor as well though, ginger can be of use to them. Crystalised ginger is a good thing to keep on hand for episodes of low blood sugar."


Audra writes,

"#1. Listen to your body. Learn how you feel during highs and lows. Your meter is your best friend in the beginning since you won't know what your new "normal" feels like.

#2. That GP IS a diabetic complication that must be managed, not ignored. Part of the management is working with a dietician to learn what foods you can tolerate that help keep your blood glucose in check. Also, that many oral medications that may be helpful for others don't work for GP because of the gastric emptying differences.

#3. It's not about coping, it's about managing. It takes time to grieve, just like when you are diagnosed with any major illness. Then you pick yourself up, make a plan and forge onwards. Learn your options, work with your providers and never stop educating yourself.

#4. I carry glucose liquid purchased at Walmart, a high protein snack bar that can withstand being "beaten up" in my bag, glucose gel tube and keep a Glucagon injection at home (since that's the most likely place I'll need it). I never know which form I'll tolerate best at any given time. If you use the injection, you will have to eat protein very shortly thereafter as it will completely destabilize your body.

#5. www.myrecipes.com to get ideas for food prep that I can tolerate. I eat primarily chicken and am always looking for ways to cook it differently. Since I have so many food allergies, I just adapt recipes to what I can tolerate at the time. Every GPer is different and even the individual's tolerance change. I feel it's best to go with what you can eat than to force yourself into eating things that make you feel worse.

The recipes I recommend are HERE."


Heather writes, "I have gp and hypoglycemia and for the first time since I was diagnosed, I had a drop for me. I'm not very low but low enough for me to notice symptoms. I just eat done crackers and it fixed."

No comments: