Finding relief for delayed stomach emptying in diabetics
By Howard Lewine, M.D.
Q: My mother is a type 1 diabetic and has been diagnosed with gastroparesis. She is suffering terribly with this disease. Is there a special diet that she can follow?
A: Gastroparesis means that the stomach muscles do not contract properly. So, fluid and food linger in the stomach far longer than normal.
Gastroparesis can be an extremely troubling complication of diabetes. It is due mainly to damage to the nerves that control flow of food from the stomach into the intestine. Elevated blood glucose levels can also contribute to the problem.
There are several approaches to try to reduce the sense of fullness, nausea and inability to eat, but they rarely bring complete relief. Recommended dietary changes include limiting fatty foods, because they delay the stomach from emptying, and limiting fresh fruits and vegetables, because fiber is difficult for the stomach to evacuate.
Also, meals should be small and frequent. If solid foods are especially hard to tolerate, put them through the blender and swallow them in liquid form. Rarely, doctors may place a feeding tube directly into the small intestine to bypass the stomach.
Every effort should be made to maximize glucose control with insulin in patients with type 1 diabetes. This might improve the symptoms. However, good glucose control can be very challenging. The variability of food absorption due to the underlying problem makes it difficult to predict the best dosing schedule for insulin.
A variety of drugs, called “prokinetic” or “promotility” agents, have been tried in patients with gastroparesis. At best, they provide partial improvement. Doctors often prescribe metoclopramide. It can have troublesome side effects, including abnormal muscles contractions in the face or body, anxiety and depression.
Erythromycin, an antibiotic, also has promotility properties. It is most likely to be helpful when delivered intravenously before eating, obviously a fairly difficult thing to do at home. Oral erythromycin works only occasionally.
(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
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