Treatment for Gastroparesis
Controlling blood sugar is the first line of defense
By Wil Dubois
Your stomach is a boxer. Lean and muscular, it punches the crap out of the competition. It's the all-time champ. Well, until it comes up against uncontrolled diabetes. Then the stomach falls flat to the mat.
Yep. Diabetes can punch you in the stomach. Elevated blood sugars can lead to one of the most difficult-to-live-with complications of uncontrolled diabetes: Gastroparesis. Literally translated gastroparesis means "paralyzed stomach." Normally, muscles in the wall of the stomach smash food to bits and shove them out of the stomach and on downstream into the small intestines. But once gastroparesis sets in, the muscles work poorly, or in severe cases, not at all, resulting in a host of digestive, nutritional, and blood sugar problems.
The root cause of gastroparesis is damage to the vagus nerve that drives the stomach muscles, making gastroparesis yet another nasty flavor of neuropathy. As you'll soon see, controlling blood sugar is the best treatment for gastroparesis, but there is other help for gastroparesis, too. But first, how would you know if you've got this complication?
Well, if your stomach receives a TKO and isn't emptying properly, you're gonna have digestive symptoms: Bloating, heartburn, stomach spasms, nausea, and even vomiting. You might even vomit un-digested food hours after eating it. (I apologize if this column is making you nauseated.) Of course with the stomach not emptying, you might feel full after even a few bites, you might rarely feel hungry, and you could even lose weight from malnutrition.
Ironically, gastroparesis makes blood sugar control even more difficult, due to inconsistent food absorption. Counting carbs doesn't count when you can't count on how many will get through the stomach, be absorbed by the intestines, and move on into the blood stream. The danger here is the whole gerbil-in-the-squirrel-cage thing. Gastroparesis makes blood sugar control worse. Bad blood sugar leads to more damage to the vagus nerve, which makes the gastroparesis still worse, which makes the diabetes control fall even further out of control, which…. Well, you get the idea.
Diabetes is the most common known cause of gastroparesis (along with botched intestinal surgery, Parkinson's, and multiple sclerosis). And, sorry, ladies, it's more common in women than in men, although no one knows why.
Beyond being a female with diabetes, increased risk factors include use of narcotic painkillers and antidepressants—both of which can cause the action of the stomach to slow independently—as well as hypothyroid conditions. As both depression and low thyroid are common in people with diabetes, the deck is really stacked against us here!
The bad news is that, like diabetes, there's no cure for gastroparesis. It's a chronic condition that won't go away. The mixed news is that gastroparesis is a "relapsing condition," meaning it comes and goes. Sometimes it's better, but sometimes it's worse; it comes in waves. The good news is that some changes in your diet and some smart use of insulin can make living with gastroparesis, well, livable.
Complications from the complication
Can this complication get any more complicated? Yes. Food that can't exit your stomach can actually ferment. Uck. That leads to the charmingly named "bacterial overgrowth" in the stomach.
Or you could get a bezoar. This is not an island off the coast of Portugal. A bezoar is a solid lump of undigested food, which can become a life-threatening complication if it acts like a cork and plugs the entrance to the small intestine.
Of course, not every pain in the stomach is gastroparesis. There are a lot of other conditions that can trigger symptoms like gastroparesis, including gallbladder disease, pancreatitis, celiac, lactose intolerance, stress ulcers, and more. If your primary care doc has reason to suspect gastroparesis, you'll be sent to a Gastroenterologist for a workup and some tests.
The most common test is a gastric-emptying study where you basically eat radioactive hotdogs and a nuclear medicine scanner called a gamma camera is used to see how long it takes your stomach to empty.
OK, I lied about the hotdogs to try a cheer you up. Sorry. I think they actually use eggs or egg substitutes.
A similar study, called an "upper GI series," uses barium, which is a chalky liquid. Or you might get scoped out. The doc can perform an endoscopy to look at what's happening inside your stomach via a small camera on the end of a thin tube that's passed down your throat. Some practices also use an ultrasound, and the latest and greatest is a "smart pill" which is a device right out of the 60's movie Fantastic Voyage. Smart pills are like miniature submarines that record data as they move through the digestive tract.
All of that is very depressing, and the best advice is to keep your damn sugar under control and avoid this whole mess in the first place. That said, if the control train has already left the station, if the A1C boat has already sailed, listen to me carefully. No matter how sick you feel right now, it can get worse. Much worse. Remember the gerbil? You need to get that varmint off the squirrel cage, and do it now. If you don't, the gastroparesis can get so bad that the stomach completely shuts down. At that point, to stay alive, you have to get a jejunostomy tube. That's a big word for a feeding tube placed straight into the intestines.
So, no matter how much effort it takes, and it will take a lot with gastroparesis, you need to get the diabetes under control so the damage stops growing.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...