HELP ON DIABETES

NERVE INJURY TO STOMACH

Longstanding diabetes can also affect the nerves that control stomach emptying and bowel function. If the nerves to the stomach are affected, stomach emptying may be delayed, causing a bloated feeling after eating. If the condition is severe, there may be vomiting of undigested food after many hours. This condition is called gastro­paresis. Normally, insulin is injected before a meal so that the peak level of the insulin matches the glucose rise after a meal. If gastroparesis is present, however, the glucose rise might be delayed—the resultant mismatch between the insulin peak and the glucose peak can cause low-glucose reactions. The gastroparesis can be intermittent and may be triggered by particular foods, for example, high-fat, high-protein foods. High glucose levels themselves can also worsen the symptoms of gastroparesis.

Gastroparesis is suspected if there is complaint of bloating, vomiting old food, and low-glucose reactions shortly after eating. Sometimes the symptoms are so con­sistent with the diagnosis that no further testing is necessary. If the diagnosis is uncertain, a test called radioisotope labeled solid food emptying is performed. In this test, an egg sandwich containing a radioactive marker is eaten and a scanner looks at the speed with which the radioactivity leaves the stomach. You can treat gastroparesis by

• Keeping the blood glucose levels stable. 
• Avoiding high-fat, high-protein foods and choosing low-fat, high-fi ber foods instead. 
• Altering the timing of the insulin injection or the oral diabetes medicines to minimize the risk of low-glucose reactions. 
• Taking medicines that improve gastric emptying: Metoclopramide (Reglan) works best if it is taken regularly three or four times a day. Side effects include anxiety and drowsiness. Sometimes, people taking metoclopramide get involuntary tics of the facial muscles (called a dystonic reaction), which go away once the medicine is stopped. If this happens, it should not be used again. Erythromycin is an antibiotic that can help stomach emptying and is given before meals. One of the problems with gastroparesis is that the gastric outlet (pylorus) does not relax properly. It has been reported that botulinum toxin (the treatment, called Botox, more popularly known to help wrinkles) injected into the pylorus can help the gastroparesis, but this is still experimental. 
• Using an electric gastric stimulator to aid gastric emptying if all the preceding treatments fail 

Nerve injury to the bowel can cause intermittent constipation, and over-the-counter laxatives may be used. Sometimes the constipation can alternate with diar­rhea, and some individuals can have mostly diarrhea with frequent liquid stools. This can be treated with antidiarrhea medicines such as diphenoxylate with atro­pine (Lomotil) or loperamide (Imodium). Rarely the diarrhea can be severe and an injectable medicine called octreotide (Sandostatin) might help.