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Diagnosing Gastroparesis – Part 4

Diabetes Solution
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 4 Chapter 22
Gastroparesis

It is worth noting that gastroparesis can be cured by extended periods of normal blood sugars. I’ve seen several relatively mild cases where special treatment was terminated after about 1 year, and blood sugar profiles remained flat thereafter. At the same time, R-R studies improved or normalized. Since my late teens, I experienced severe daily belching, and burning in my chest. These symptoms gradually eased off, and eventually disappeared, but only after thirteen years of nearly normal blood sugars. My last R-R study was normal. The “sacrifices” in lifestyle required for treatment of gastroparesis may really pay off months or years later. The vagus nerve doesn’t control only stomach emptying—there are a number of other complications resulting from impaired vagus function that can be reversed by maintaining normal blood sugars. The regained ability to sustain a penile erection is an important one for many of my male patients.

Once gastroparesis has been confirmed as the major cause of high overnight blood sugars and wide random variations in blood sugar profiles, we can begin to attempt to control or minimize its effects. If your blood sugar profiles reflect significant gastroparesis, there is no way to get them under control by only juggling doses of insulin. There’s just too much danger of either very high or very low blood sugars for such approaches to work. The only chance for effective treatment is to concentrate on improving stomach-emptying.

How do we do this?
We have four basic approaches. First is the use of medications. Second is special exercises or massage during and after meals. Third is meal plan modification utilizing ordinary foods, and fourth is meal plan modification utilizing semiliquid or liquid meals. It’s unusual for a single approach to normalize blood sugar profiles fully, so most often we try a combination of these four approaches, adapted to the preferences and needs of the individual. As these attempts
start to smooth out blood sugars, we must modify our doses of insulin or ISAs accordingly.

The guidelines that we use to judge the efficacy of a given approach or combination of approaches are these:

• Reduction or elimination of physical complaints such as early satiety, nausea, regurgitation, bloating, heartburn, belching, and constipation
• Elimination of random postprandial hypoglycemia
• Elimination of random, unexpected high fasting blood sugars—probably the most common sign of gastroparesis that we encounter
• Flattening out of blood sugar profiles

Remember that the last three of these improvements may not be possible even without gastroparesis if you’re following conventional dietary and medication regimens for “control” of your blood sugar. For example, I know of no way that will truly flatten out blood sugar profiles if you’re on a high-carbohydrate diet and the associated large doses of insulin.

Medications That Facilitate Stomach-Emptying
There is no medication that will cure gastroparesis. The only “cure” is months or years of normal blood sugars. There are, however, some pharmaceutical preparations that may speed the emptying of your stomach after a meal if your gastroparesis is only mild or moderate in severity (page 361, footnote). These will help smooth out your blood sugar profiles after that meal. Most diabetics with mild to moderate gastroparesis will require medication before every meal.

When gastroparesis is very mild, it may be possible to get away with medication only before supper. For some reason—perhaps because most people tend not to be as physically active after supper, and may have their largest meal of the day in the evening—digestion of supper appears to be more impaired than that of other meals. It is also likely that stomach-emptying is slower in the evening, even for nondiabetics.

Medications for gastroparesis may take the form of liquids or pills. The question immediately arises that if pills must dissolve in the stomach to become effective, just how effective are they going to be? My experience is that they’re of questionable value unless chewed. The time required for a pill to dissolve in a paretic stomach is likely to be lengthy, and consequently the medication may take several hours to become effective. I generally prescribe only liquid medications or chewed tablets for stimulating gastric (stomach) emptying.


We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet.

Copyright © 2005 by Richard K. Bernstein, M.D. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

Author’s Note:
This book is not intended as a substitute for professional medical care. The reader should regularly consult a physician for all health-related problems and routine care.

For more information on Dr. Bernstein’s and to purchase his books, CD’s or get access to his free monthly webinars, visit his website at DiabetesBook.com.