If you believe the American Diabetes Association, something in the order of 50%of diabetics suffer from slow gastric transit in one form or another, and it is directly a consequence of high blood glucose levels.
This extends from simply food taking longer to get through the body than normal, to full on Gastroparesis. And sadly, far fewer seem to be aware that they may actually be suffering from this form of Autonomic Neuropathy than you might expect, and anecdotal evidence suggests that not as many healthcare professionals are fully aware of it as they perhaps should be.
Starting at the widely read blog of Ninjabetic, you have an anecdotal view of what can happen. Six years after identifying the issues with being able to eat, the NHS finally agreed that she should be tested for, and had gastroparesis. I say it’s not unusual, as, sadly, it’s not. If you read the counts on many Diabetes internet forums, there are plenty of people who suffer slow gastric transit in some form or another. And working out how to deal with it is pretty tricky.
This study from ADA suggests that it isn’t always obvious that there are issues, either. In fact, the more you read about it, the more that you start to wonder how quickly it pervades a Diabetic’s life?
The more I dig into this, the more I find tha “Diabetic Stomach” has had a lot of papers written about it, for example, this one looks at approaches to dealing with the issue for both patients and medical staff. It cites many reference texts that go back more than 50 years in one case. Clearly then, Diabetes and delayed gastric emptying have been known about for a long time, yet the literature suggests that symptoms can be hard to spot, and often those with symptoms that could be this don’t necessarily have it. Talk about a sneaky complication!
A further study here suggests that long term glycaemic control isn’t the cause, and that specific glycaemic control, rather than long term, isn’t immediately responsible either. Opposing that is this population study which suggests that long term glycaemic control is an issue. Anecdotally, this also seems to be the case. Other studies also suggest that having a wide variance in your blood glucose levels accentuate slow transit and working to keep those suitably flat will also make a difference.
It’s also fair to say that being female seems to increase the risk.
As an initial overview, this should be a reasonably well known side effect of diabetes that you might expect most Diabetes clinicians to know about and have a strategy to deal with patients. That it can be confused with a number of other issues complicates the matter and means that diagnosis can take longer than desired.
Diagnosis and Treatment
But what if you suspect that you may have this condition? The symptoms could be many gastro-intestinal tract issues, and are usually some of:
- A feeling of fullness after eating just a few bites
- Abdominal bloating
- Abdominal pain
- Changes in blood sugar levels – hypos that shouldn’t occur after eating, delayed highs
- Lack of appetite
- Weight loss and malnutrition
However, it can also be asymptotic…
And if you have symptoms and need a diagnosis? Well the gold standard diagnostic test, at least in the UK is the “Shapes” test. What is this? Well, the description is:
A transit study (also known as a colonic marker study or sitz markers) is usually performed next. To carry out a transit study; on one or more days the patient swallows a capsule containing tiny rings that show up on an x-ray. After five to seven days, x-rays are taken in order to count the markers and note their positions. In a normal study, less than 20% of the markers are left remaining in the colon. Markers scattered throughout the colon and / or even in the small intestine, suggest a marked delay in gut transit; while markers concentrated in a single area suggest a blockage below the markers.*
Basically, if you have delayed Gastric Transit then those little shapes take a long time to make their way through your guts!
Once you are diagnosed, the thing that seems to be most recommended is to control your blood glucose levels to the best of your abilities. With Gastro affecting you, this is much harder than it should be as insulin timing becomes that much more difficult. With modern fast acting insulins, timing will become everything, although there may be good reason to ask for ones like Actrapid, which has a much slower onset than those like Humalog and may better match your digestive transit.
This document from the BMJ suggests a number of approaches for treatment, including diet, drugs and Gastro Electrical Stimulation.
Other diet related suggestions include:
- Eat smaller meals more frequently
- Chew food thoroughly
- Eat well-cooked fruits and vegetables rather than raw fruits and vegetables
- Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars
- Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet
- If liquids are easier for you to swallow, try soups and pureed foods
- Drink water throughout each meal
- Exercise gently after you eat, such as going for a walk
- Avoid carbonated drinks, alcohol and smoking
There are also some drugs that can be taken, but they seem to have limited success, in fact the most successful treatment seems to be Gastro Electrical Stimulation, however the last look at this from NICE was in 2004. Since then, the Scottish Healthcare system has looked at it, and this overview suggests that as a resolution for Gastro, it is very successful. I’d suggest that getting hold of it would be more difficult.
In any case, slow gastric transit is a very real problem for an awful lot of diabetics. Equally, it is unseen and hard to diagnose. It may not be so bad as to require a feeding tube, however, it can have a significantly detrimental affect on a sufferer’s life. Just read the Ninjabetic’s blog to see how bad, and consider, if you feel the symptoms of dyspepsia, it may be the initial signs of something else. If it persists, get it checked out properly. Just don’t expect anything to happen quickly!
*Taken from Digestive Distress