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A Lot to Digest
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Tummy troubles? What can go wrong—and what you can do about it
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By Meryl Davids Landau
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Diabetes Focus First Quarter 2008
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 Changes in circulation and nerve health associated with diabetes can trigger a wide range of digestive problems. Here are some common complaints and what to do about them.
Gastroparesis is the most commonly recognized digestive complication of diabetes. It strikes when the vagus nerve, which helps nerves and muscles move food from the stomach to the intestines, becomes damaged (with diabetes, chronic high glucose levels are to blame). Neuropathy develops; food then moves slowly or stops moving through the digestive tract.
Signs and symptoms of gastroparesis are pain in the upper abdomen, heartburn, nausea, vomiting of undigested food (sometimes several hours after a meal), a feeling of fullness after just a few bites of food, weight loss resulting from poor absorption of nutrients or low calorie intake, abdominal bloating, high and low blood glucose levels, lack of appetite, acid reflux and spasms in the stomach area.
What goes wrong
When food can’t be digested and moved out of the stomach, it may ferment, leading to bacterial overgrowth that causes nausea and vomiting. And it can harden into bezoars, solid masses that may cause nausea, vomiting and stomach obstructions. These can be dangerous if they block the passage of food into the small intestine. Gastroparesis also causes glucose levels to fluctuate unpredictably, since food isn’t absorbed as anticipated.
What to do
Treatments depend on the severity of the symptoms. Several are available:
- Metoclopramide stimulates stomach muscle contractions to help emptying.
- Antibiotics can clear up a bacterial infection. The antibiotic erythromycin improves stomach emptying.
- An endoscope may be used to inject medication into the stomach if you have a bezoar.
- Eating up to six small meals a day may make it easier for your stomach to handle food; so can eliminating high-fat and high-fiber foods from your diet.
- Sometimes an electric gastrostimulator implanted into the torso can ease nausea and vomiting.
- In the most advanced cases, serious steps may have to be taken, including the use of a feeding tube.
If you reflux food twice a week or more, you may have gastroesophageal reflux disease (GERD).
What goes wrong
Weakness in the lower esophageal sphincter allows stomach contents, including digestive acid, to leap from the stomach back into the esophagus.
What to do
For occasional heartburn, try drugstore antacids. Treating GERD requires lifestyle changes (such as losing weight and stopping smoking), medication (primarily proton pump inhibitors) and, rarely, surgery.
A chronic inflammatory disease of the intestines (especially the lower small intestine) associated with sores, pain, rectal bleeding, diarrhea and, sometimes, blockages, it is now known to be linked genetically to type 1.
What goes wrong
While genes are believed to play a role, scientists aren’t sure what else may be involved. One popular theory: The autoimmune response is evoked when, for unknown reasons, the body overreacts to normal bacteria and other substances in the intestines, launching attacks on innocent tissue.
What to do
There’s no cure, but steroids, antibiotics, immune-system suppressors and surgery ease symptoms, sometimes for long stretches.
As many as one in five Americans suffers from IBS and the frequent abdominal pain, bloating, constipation and/or diarrhea it causes.
What goes wrong
Diabetes does not cause IBS, but they may coincide, and IBS symptoms are similar to diabetes-related digestive problems: oversensitivity to food, constipation, diarrhea, straining, urgency or the feeling of incomplete bowel movement.
What to do
Avoid troublesome foods and talk to your doctor about medications ranging from laxatives, antidiarrheals and antispasmodics to antidepressants. Stress management, via exercise, meditation and enough sleep, may also help.
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