Gastroparesis: A Little-Known but Common Disorder in Type 1 Diabetes

Digestion is skillfully coordinated by the human body. When we eat, food moves through our digestive system section by section, spending just the right amount of time in each. For the stomach, that’s about two hours.

Sometimes digestion can be impaired. This occurs when the nerves controlling stomach muscles are damaged or not functioning properly and stomach emptying is slowed. This is called gastroparesis. 

Gastroparesis and diabetes

Although the cause of this condition is unknown in more than a third of cases, gastroparesis can be a complication of diabetes. It’s more common in people who have been living with diabetes for some time and have other complications (e.g., nerve, kidney or eye damage) than in people without diabetes. 

As symptoms of gastroparesis may be associated with other conditions, the number of people affected is likely underestimated. However, it’s known that people living with type 1 diabetes (T1D) are at greater risk of developing this complication than those living with type 2 diabetes (T2D). Gastroparesis is estimated to affect between 27% and 65% of people living with T1D, and women are up to four times more likely to develop this disorder than men.

Impact on blood suga

Gastroparesis can make managing blood sugar more difficult for people living with T1D. Since digestion is slowed once food reaches the stomach, the arrival of glucose (sugar) in the blood may be delayed, unpredictable, and no longer correspond to the timing of insulin action.

If insulin is taken before a meal, as recommended, it could start acting before the delayed arrival of glucose in the blood, causing hypoglycemia. 

As digestion slows, glucose could enter the blood after insulin has stopped acting, causing hyperglycemia.

Therefore, one might need to adjust the dosage and timing of their insulin to limit these risks. Artificial pancreases can also help manage blood sugar in gastroparesis since they automatically adjust basal insulin (e.g., by decreasing or increasing the basal insulin rate if there’s a risk of hypoglycemia or hyperglycemia). 

Identifying gastroparesis

Gastroparesis is sometimes difficult to diagnose, because the type, frequency and intensity of symptoms can vary from person to person.

The most common symptoms experienced are: 

• Nausea and vomiting
• Feeling full soon after starting a meal
• Bloating
• Abdominal pain
• High fluctuations in blood sugar
• Weight loss

If you present symptoms of gastroparesis, your doctor may request additional blood tests and perform specific tests to confirm a diagnosis.

Gastric emptying is the most widely used test for diagnosis. It measures the rate at which food is digested. To begin, the patient must eat a meal containing a small amount of a substance that will be visible during radiological tests. Pictures of the digestive tract are then taken at different intervals after the meal to assess its progression.

Treatment options

Gastroparesis treatment can involve making simple changes to eating habits, taking medication or, in the most severe cases, undergoing surgery.

In mild cases, it’s sometimes possible to reduce symptoms by changing eating habits (e.g., eating smaller meals more frequently, opting for softer or liquid foods, limiting fat or fibre).

Although there’s no cure for gastroparesis, some medications can still help reduce symptoms, for instance, by increasing digestive motricity to cause the stomach to empty more quickly, or by relieving nausea and vomiting.

If your symptoms can’t be controlled despite changes to your eating habits or medications, the need for surgery should be assessed with your doctor.

Because gastroparesis adds another “layer” to the complexity of managing blood sugar, it can decrease the quality of life and increase anxiety in people with diabetes.

However, research has shown that technologies such as insulin pumps or continuous glucose monitoring (CGM) systems can make it easier to manage blood sugar and improve quality of life.

If you have any questions or concerns, please reach out to your doctor or healthcare team. Talking to a mental health professional who is familiar with diabetes can also help you confront the diagnosis and this new normal.

References : 

• Choung RS, Locke GR III, Schleck CD et al. Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population. Am J Gastroenterol 2012;107:82–88.
• Association Française de Formation Médicale Continue en Hépato-Gastro-Entérologie, « Gastroparésie : Quand y penser ? Comment traiter ? », consulté le 9 février, https://www.fmcgastro.org/postu-main/archives/postu-2011-paris/textes-postu-2011-paris/gastroparesie-quand-y-penser-comment-traiter/
• Société Gastro-intestinal 2022, « Gastroparésie », consulté le 9 février 2023, https://badgut.org/centre-information/sujets-de-a-a-z/gastroparesie/?lang=fr
• Krishnasamy, Sathya, and Thomas L Abell. “Diabetic Gastroparesis: Principles and Current Trends in Management.” Diabetes therapy : research, treatment and education of diabetes and related disorders vol. 9,Suppl 1 (2018): 1-42. doi:10.1007/s13300-018-0454-9
• Young, Clipper F et al. “Diabetic Gastroparesis: A Review.” Diabetes spectrum : a publication of the American Diabetes Association vol. 33,3 (2020): 290-297. doi:10.2337/ds19-0062
• Calles-Escandón J, Koch KL, Hasler WL, et al. Glucose sensor-augmented continuous subcutaneous insulin infusion in patients with diabetic gastroparesis: An open-label pilot prospective study. Plos one. 2018 ;13(4):e0194759. DOI: 10.1371/journal.pone.0194759.