Diabetes and gastric problems

Diabetes is associated with a number of complications — including cardiovascular conditions, kidney disease, blindness and gastric (stomach) problems [1, 2]. 

In this article, we’ll be focusing on diabetes and gastric problems. If you have diabetes and wonder what effect it could have on your digestion or if you are having stomach symptoms, this article may help you learn a little more about what might be going on.

Diabetes and digestion: how are they connected?

Diabetes can cause damage to many different systems in the body, one of which is the nervous system [2]. This damage is called neuropathy [2].

Neuropathy can be divided into many abnormalities, including autonomic neuropathy (DAN), which affects the thin autonomic nerves around the body [2]. Lots of different organs can be affected by autonomic neuropathy, including the heart and blood vessels, kidneys, bladder, and the gastrointestinal system (the digestive system) [2].

Diabetic autonomic neuropathy (DAN) can lead to problems with the muscles in the oesophagus, gastroparesis and a range of intestinal problems such as diarrhoea and incontinence [2].

Heartburn and diabetes

It has been found that people with diabetes are at a greater risk of having a condition known as gastro-oesophageal reflux disorder (GORD) than those without diabetes [3].

GORD is caused by the acidic stomach contents travelling back up into the oesophagus (food pipe) and leading to irritation (sometimes known as acid reflux) [3]..

Symptoms of GORD can include heartburn, chest pains and acid-tasting fluid coming back up into the mouth [3].

It is not entirely clear why diabetes may put you at a higher risk of reflux, but studies have shown that being overweight and obesity are important independent risk factors for GORD [3]. Some people with diabetes (especially type 2 diabetes) are obese, which may be one reason why diabetes causes the condition [3]. It has also been suggested that diabetic autonomic neuropathy may play a part [3].

Diabetic gastroparesis

Diabetic gastroparesis is a complication of diabetes that is characterised by your stomach taking longer to empty than normal — known as delayed gastric emptying (GE)  [1].

One study found that up to 50% of people with either type 1 or type 2 diabetes and suboptimal blood glucose management had delayed gastric emptying [1].

Not everyone with delayed GE will have a diagnosis of gastroparesis; some people will have no symptoms at all, and others will only have mild to moderate heartburn [1]. To have a diagnosis of gastroparesis, you will have moderate to severe gastrointestinal symptoms and delayed GE, which your doctor will have shown using specialist investigations [1].

The delayed gastric emptying seen in gastroparesis may have a range of underlying causes, which could include high blood glucose (hyperglycaemia), diabetic autonomic neuropathy, and damage to the muscles and nerves due to inflammation [1].

Gastroparesis can have a significant effect on a person’s quality of life; up to half of those with the condition have anxiety and/or depression [1].

Gastroparesis symptoms

Gastroparesis symptoms can include [1]:

• Feeling full sooner in a meal than you would expect
• Feeling excessively full after a meal
• Nausea
• Vomiting
• Bloating
• Pain in the upper abdomen
• Weight loss

Many of these symptoms can also be due to other conditions, some serious, so if you are experiencing any of the above, make sure to see your doctor.

Complications of gastroparesis

Gastroparesis alters how food moves through your digestive system, which could lead to difficulties managing your blood glucose [1, 2]. 

In some cases, gastroparesis can cause you to not absorb enough nutrients from your food, leading to nutritional deficiencies and dehydration [2].

Having significant gastroparesis makes it more likely that you will have to be admitted to hospital [1]. In extreme cases, it may even be life-threatening [1].

Gastroparesis treatment

The main aims of gastroparesis treatment are to reduce the symptoms that you might have, to ensure that you are getting enough nutrition, and to help improve your quality of life [1].

The first-line treatment is often medication to manage nausea and vomiting (antiemetics) [1].

Your healthcare team may suggest that you make changes to your diet to help reduce your symptoms [1]. This may mean eating foods that are low in fat, low in fibre, and have a small particle size [1].

In more severe cases where your body is having trouble getting all the nutrients it needs from food, your healthcare team may consider nutritional supplements [1]. This may mean having liquid food given through a tube inserted through the skin of the stomach [1].

In very rare cases, it may be necessary to perform surgery on the stomach to help treat the condition [1].

Diabetes and bacterial infections

If your diabetes is not well managed, it can put you at risk of infections in many different parts of the body, including the skin, bones, ears, lungs, urinary tract and gastrointestinal system [4]. Poor blood glucose levels are associated with serious infections [4].

It is thought that high blood glucose may interfere with the ‘barrier function’ of the gut, which prevents bacteria and other pathogens from getting into the body [4].

One example of a gastrointestinal infection is H. pylori — a cause of stomach inflammation and ulcers which has been found to occur more commonly in people with type 2 diabetes [5].

The rates of this type of infection are higher for those with type 2 diabetes and those who are older [5]. The cause of the higher rates of H. pylori in people with diabetes is not entirely clear and is still under investigation [5].

Preventing stomach problems if you have diabetes

There are a number of steps that you can take to reduce your risk of stomach problems [2, 3]. 

As true of any complication of diabetes, diabetic gastroparesis can be prevented by good blood glucose management, starting from early in your diabetic journey [2].

Hydration and nutrition are also important in preventing lots of complications of diabetic gastroparesis and autonomic neuropathy, including diabetic ketosis/ketoacidosis, delayed wound healing and diabetic cachexia [2]. Having the support of a nutritionist familiar with gastroparesis nutrition may help [2].

Reflux can prevented by keeping your HbA1c level low [3]. Maintaining your ideal weight can also be beneficial for reducing reflux [3].

Diabetes and gastric problems: key takeaways

Diabetes is associated with several stomach problems, including reflux, problems with the emptying of the stomach, and infections [1]. 

Having high blood glucose or complications like diabetic neuropathy may play a part in the stomach issues associated with diabetes [1].

Your healthcare team may suggest several things you can do to help your symptoms, including changes to your diet, ensuring your blood glucose levels are well managed and that you maintain your ideal weight [1, 3].

Your team may recommend medications to help your symptoms, but occasionally other treatments may be needed [1].

If you have any concerns about your diabetes management or think that you might have symptoms from a complication that involves your stomach, then your diabetes team will be able to help.