Treatments for Diabetic Gastroparesis
Treatments for Diabetic Gastroparesis
The list of treatments mentioned in various sources
for Diabetic Gastroparesis
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
- Diabetic blood sugar control
- Medications
- Diet changes
- Smaller meals more often, liquid meals, low-fat diet, low-fiber diet
- Endoscopic injections - for bezoars
- Feeding tube (jejunostomy tube) - a tube directly into the intestine bypassing the stomach; severe cases only
- Intravenous feeding (Parenteral nutrition) - severe cases only; often for temporary relief in hospitalization
- Anti-nausea medication
- Anti-heartburn medication
- Emergency treatment - prolonged gastroparesis can cause you to be poorly fed or malnourished.
Diabetic Gastroparesis: Is the Diagnosis Correct?
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Diabetic Neuropathy The Nerve Damage of Diabetes: NIDDK (Excerpt)
For patients with mild symptoms of
slow stomach emptying, doctors suggest eating small, frequent meals and
avoiding fats. Eating less fiber may also relieve symptoms. For patients
with severe gastroparesis, the doctor may prescribe metoclopramide, which
speeds digestion and helps relieve nausea. Other drugs that help regulate
digestion or reduce stomach acid secretion may also be used or
erythromycin may be prescribed. In each case, the potential benefits of
these drugs need to be weighed against their side effects.
(Source: excerpt from Diabetic Neuropathy The Nerve Damage of Diabetes: NIDDK)
Gastroparesis and Diabetes: NIDDK (Excerpt)
The primary treatment goal for gastroparesis
related to diabetes is to regain control of blood glucose levels.
Treatments include insulin, oral medications, changes in what and when you
eat, and, in severe cases, feeding tubes and intravenous feeding.
It is important to note that in most cases treatment does not cure
gastroparesis--it is usually a chronic condition. Treatment helps you
manage the condition so that you can be as healthy and comfortable as
possible.
Insulin for blood glucose control in people with diabetes
If you have gastroparesis, your food is being absorbed more slowly and
at unpredictable times. To control blood glucose, you may need to
- Take insulin more often.
- Take your insulin after you eat instead of before.
- Check your blood glucose levels frequently after you eat,
administering insulin whenever necessary.
Some doctors recommend taking two injections of intermediate insulin
every day and as many injections of a fast-acting insulin as needed
according to blood glucose monitoring. The newest insulin, lispro insulin
(Humalog), is a quick-acting insulin that might be advantageous for people
with gastroparesis. It starts working within 5 to 15 minutes after
injection and peaks after 1 to 2 hours, lowering blood glucose levels
after a meal about twice as fast as the slower-acting regular insulin.
Your doctor will give you specific instructions based on your particular
needs.
Medication
Several drugs are used to treat gastroparesis. Your doctor may try
different drugs or combinations of drugs to find the most effective
treatment.
- Metoclopramide (Reglan). This drug stimulates stomach muscle
contractions to help empty food. It also helps reduce nausea and
vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at
bedtime. Side effects of this drug are fatigue, sleepiness, and
sometimes depression, anxiety, and problems with physical movement.
- Erythromycin. This antibiotic also improves stomach emptying.
It works by increasing the contractions that move food through the
stomach. Side effects are nausea, vomiting, and abdominal cramps.
- Domperidone. The Food and Drug Administration is reviewing
domperidone, which has been used elsewhere in the world to treat
gastroparesis. It is a promotility agent like cisapride and
metoclopramide. Domperidone also helps with nausea.
- Other medications.Other medications may be used to treat
symptoms and problems related to gastroparesis. For example, an
antiemetic can help with nausea and vomiting. Antibiotics will clear up
a bacterial infection. If you have a bezoar, the doctor may use an
endoscope to inject medication that will dissolve it.
Meal and food changes
Changing your eating habits can help control gastroparesis. Your doctor
or dietitian will give you specific instructions, but you may be asked to
eat six small meals a day instead of three large ones. If less food enters
the stomach each time you eat, it may not become overly full. Or the
doctor or dietitian may suggest that you try several liquid meals a day
until your blood glucose levels are stable and the gastroparesis is
corrected. Liquid meals provide all the nutrients found in solid foods,
but can pass through the stomach more easily and quickly.
The doctor may also recommend that you avoid fatty and high-fiber
foods. Fat naturally slows digestion--a problem you do not need if you
have gastroparesis--and fiber is difficult to digest. Some high-fiber
foods like oranges and broccoli contain material that cannot be digested.
Avoid these foods because the indigestible part will remain in the stomach
too long and possibly form bezoars.
Feeding tube
If other approaches do not work, you may need surgery to insert a
feeding tube. The tube, called a jejunostomy tube, is inserted through the
skin on your abdomen into the small intestine. The feeding tube allows you
to put nutrients directly into the small intestine, bypassing the stomach
altogether. You will receive special liquid food to use with the tube. A
jejunostomy is particularly useful when gastroparesis prevents the
nutrients and medication necessary to regulate blood glucose levels from
reaching the bloodstream. By avoiding the source of the problem--the
stomach--and putting nutrients and medication directly into the small
intestine, you ensure that these products are digested and delivered to
your bloodstream quickly. A jejunostomy tube can be temporary and is used
only if necessary when gastroparesis is severe.
Parenteral nutrition
Parenteral nutrition refers to delivering nutrients directly into the
bloodstream, bypassing the digestive system. The doctor places a thin tube
called a catheter in a chest vein, leaving an opening to it outside the
skin. For feeding, you attach a bag containing liquid nutrients or
medication to the catheter. The fluid enters your bloodstream through the
vein. Your doctor will tell you what type of liquid nutrition to use.
This approach is an alternative to the jejunostomy tube and is usually
a temporary method to get you through a difficult spell of gastroparesis.
Parenteral nutrition is used only when gastroparesis is severe and is not
helped by other methods.
(Source: excerpt from Gastroparesis and Diabetes: NIDDK)
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Book Excerpts: Treatment of Diabetic Gastroparesis
Treatments of Diabetic Gastroparesis: Online Medical Books
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Diabetes mellitus:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment normalizes blood glucose and decreases complications using insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump. Insulin may be rapid acting, intermediate acting, long acting, or a combination of rapid acting and intermediate acting; it may be standard or purified, and it may be derived from beef, pork, or human sources. Purified human insulin is used commonly today. Pancreas transplantation is experimental and requires chronic immunosuppression.
Successful treatment requires an extensive dietary education. The patient’s diet is specifically tailored to include the right amount and combination of foods. Almost all foods may be eaten occasionally. The diet should address dietary prescriptions as well as personal and cultural preferences to improve adherence and control. For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1 diabetes, the calorie allotment may be high, depending on growth stage and activity level.
Type 2 diabetes may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, and suppress hepatic gluconeogenesis.
Five types of drugs have been used to treat diabetes. Sulfonylureas stimulate pancreatic insulin release, increase tissue sensitivity to insulin, and require insulin’s presence to work. Meglitinides cause immediate, brief release of insulin and are taken immediately before meals. Biguanides decrease hepatic glucose production and increase tissue sensitivity to insulin. Alpha-glucosidase inhibitors slow the breakdown of glucose and decrease postprandial glucose peaks. The thiazolidinediones enhance the action of insulin; however, insulin must be present for them to work. These drugs also reduce insulin resistance by decreasing hepatic glucose production and increasing glucose uptake. They have also been shown to lower blood pressure in diabetic hypertensive patients. Cholesterol and triglyceride levels may also be reduced.
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
Alert Any patient with a wound that has lasted more than 8 weeks and who has tried standard wound care and revascularization without improvement should consider hyperbaric oxygen therapy. This treatment may speed healing by allowing more oxygen to get to the wound and may therefore result in fewer amputations.
Keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy, nephropathy, and neuropathy. In type 2 diabetes, blood pressure control as well as smoking cessation reduces the onset and progression of complications, including cardiovascular disease.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Intestinal obstruction:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Surgery, nasogastric tube, total parenteral nutrition, supportive care (I.V. fluids, bed rest)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Diabetes mellitus:
Treatment
(Handbook of Diseases)
Effective treatment for both types of diabetes normalizes blood glucose and decreases complications.
Type 1 diabetes
Treatment includes insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump.
Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente, Lantus), or a combination of rapid-acting and intermediate-acting (70/30, 75/25, or 50/50 of NPH and Regular).
Clinical tip Insulin Lispro or Novalogue may be used in place of Regular insulin. It’s rapid in onset (15 minutes) and makes waiting to eat after injection unnecessary. It has a short duration of action (4 hours), which decreases between-meal and nocturnal hypoglycemia.
Islet cell or pancreas transplantation is available and requires chronic immunosuppression.
Type 2 diabetes
Patients may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates.
UNDER STUDY: Studies have shown that treatment with a lipase inhibitor (such as orlistat) combined with a low-calorie diet significantly decreases the weight of overweight patients with type 2 diabetes. Patients following this therapy also displayed improvements in glycemic control and cardiovascular risk profile; levels of glycosylated hemoglobin, fasting glucose, and postprandial glucose improved significantly.
Both types
Treatment of both types of diabetes requires a diet planned to meet nutritional needs, to control blood glucose levels, and to reach and maintain appropriate body weight.
For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently and meals eaten at regular times.
UNDER STUDY: Vitamin E is under investigation for its cellular effects that can possibly reduce the risk of macrovascular disease in patients with type 2 diabetes mellitus. The antioxidant effects of vitamin E were supported, and it was found that, in high doses, vitamin E acts as an anti-inflammatory. It’s postulated that heart disease and stroke risk can be decreased because vitamin E reduces plaque formation at the endothelial level. Vitamin E may also have an effect on the metabolic syndrome that causes diabetes mellitus and may prevent the disease from occurring.
Complications
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
The Diabetes Control and Complications Trial has proved that intensive insulin therapy that focuses on keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy (up to 63%), nephropathy (up to 54%), and neuropathy (up to 60%).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Intestinal obstruction:
Treatment
(Handbook of Diseases)
Initial therapy involves correcting fluid and electrolyte imbalances, resting the bowel by decompressing it to relieve vomiting and distention, maintaining nothing by mouth status, and treating shock and peritonitis. A strangulated obstruction usually necessitates blood replacement as well as I.V. fluid administration. Nasogastric tube suction is necessary to relieve vomiting and abdominal distention.
Close monitoring of the patient’s condition determines the duration of treatment; if the patient fails to improve or if his condition deteriorates, surgery is necessary. Surgery is performed on all patients with large-bowel obstruction.
Total parenteral nutrition may be appropriate if the patient suffers a protein deficit from chronic obstruction, postoperative or paralytic ileus, or infection.
Drug therapy includes an analgesic and a sedative. An antibiotic is given for peritonitis due to bowel strangulation or infarction. A broad-spectrum antibiotic should be given to provide anaerobic and gram-negative coverage.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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