By Cory Martin 

 Medically reviewed by Ana Maria Kausel, MD

Diabetes can lead to complications throughout the body and commonly causes digestive disorders such as gastroparesis (delayed emptying of the stomach). This can lead to stomach problems and pain.

Diabetes is a chronic condition in which the body either doesn’t make enough insulin (a hormone that allows cells to take in glucose from the blood) or doesn’t use it well. This ineffective use of insulin causes high blood sugar, which is the main marker of diabetes.

The two main types of diabetes are type 1 and type 2. Type 1 diabetes is an autoimmune disease in which the immune system mistakenly destroys the cells that produce insulin. Type 2 diabetes occurs when the body does not regulate or use insulin properly.1

Although there is no cure for diabetes or gastroparesis, there are ways to manage the diseases and live well. This article will discuss symptoms, risk factors, and prevalence of diabetic gastroparesis and how to manage the accompanying stomach pain.

Diabetes and Digestion

Diabetes can affect the entire digestive system causing a variety of symptoms, such as heartburn and diarrhea. The most common effect of diabetes on the digestive system is gastroparesis.2

What Is Gastroparesis?

Gastroparesis, also called delayed gastric emptying, is a disorder that affects digestion. With gastroparesis, the movement of food from the stomach to the small intestine is slowed or stopped even though nothing is blocking the stomach or small intestine.3

In gastroparesis, the vagus nerve, which controls muscles of the stomach and small intestine, is damaged, resulting in slowed or stopped movement of food. Other cells in the stomach can also be damaged and cause the stomach to stop emptying its contents.4

Risk Factors and Prevalence

Gastroparesis is a common complication of diabetes. About 20%–50% of people with diabetes will experience diabetic gastroparesis.5 Gastroparesis is more common in people who have type 1 diabetes and in those who have had type 2 diabetes for more than 10 years.

Having poor control of blood sugar, retinopathy (damage to the light-sensing tissue at the back of the eye), or neuropathy (nerve damage) are risk factors associated with increased rates of diabetic gastroparesis.5

Being female, smoking, and having obesity can also raise the risk for gastroparesis.6

Symptoms of Diabetic Gastroparesis

Symptoms of diabetic gastroparesis include:

• Feeling full early in a meal

• Feeling full long after eating

• Nausea

• Vomiting

• Bloating

• Pain in the upper stomach2

• Belching

• Heartburn

• Poor appetite4

Diagnosis and Tests

To diagnose gastroparesis your healthcare provider will talk with you about your symptoms and medical history, conduct a physical exam, and perform a variety of medical tests.

During the exam they will check your blood pressure, look for signs of dehydration and malnutrition, and check your abdomen for tenderness, pain, and unusual sounds.

Several different types of medical tests can be used to confirm a diagnosis of gastroparesis. These tests include the following:

Lab tests: Blood tests can show if levels of glucose are too high or low. They can also show signs of dehydration, malnutrition, infection, and inflammation. Urine tests can show signs of dehydration as well.

Imaging tests: An upper GI endoscopy (a thin tube with a camera is inserted through the mouth into the stomach and intestine) or abdominal ultrasound (using sound waves to produce images) can allow a healthcare provider to rule out obstructions that may be causing a blockage.

Stomach emptying tests: These tests can be used to determine how fast your stomach empties its contents. These include:

• Gastric emptying scan: During this scan, a bland meal that contains a small amount of radioactive material is consumed. A camera outside the body follows the radioactive material to see how long it takes to leave the stomach.

• Gastric emptying breath test: During this test, you consume a meal containing a substance that is absorbed in the intestines and causes changes to your breath. After the meal, breath samples are taken over the course of four hours to see how long it takes for the substance to leave the stomach and enter the intestines.

• Wireless motility capsule (SmartPill): This small device is swallowed. It records and transmits information as it passes through the digestive tract. The information is interpreted to see how long food takes to move through your digestive system. The SmartPill leaves the body through a bowel movement.7

How to Manage Diabetic Stomach Pain

Having well-controlled blood sugar is the most important factor in managing diabetic stomach pain.5 Diabetic gastroparesis can also be managed using medication, nutrition, and making certain lifestyle changes.

Medication

Medications used to control blood sugar are important to the management of gastroparesis. Insulin therapy, either through injections or an insulin pump (a wearable device that delivers insulin), is imperative as oral agents may upset the stomach.5

Since diabetic gastroparesis has a huge effect on food digestion, glucose levels may fluctuate unpredictably. For those with type 1 diabetes, continuous glucose monitoring (a wearable device monitors glucose) may be more effective in monitoring and maintaining optimal blood sugar levels.5

To help with symptoms of gastroparesis, your healthcare provider might also use a combination of other medications. These medications include:

• Reglan (metoclopramide) is used to improve food movement through the stomach and treat nausea and vomiting.

• Domperidone is used to accelerate gastric emptying and help reduce other symptoms. However, the Food and Drug Administration (FDA) has not fully approved the drug, and it is only available through the FDA’s Investigational New Drug program.

• Erythromycin is an antibiotic that helps with gastric emptying.

• Antiemetics can help with nausea and vomiting.

• Low-dose tricyclic antidepressants can relieve pain, nausea, and vomiting.5

Diet and Nutrition

Diabetic gastroparesis often causes nutrition deficiencies. An experienced dietitian can address these deficiencies and make dietary suggestions that may help alleviate some of the pain associated with the disorder.

Changes to make include:

• Eating smaller, more frequent meals

• Chewing thoroughly and taking 20–30 minutes to eat a meal

• Eating liquid meals or blended foods to give the stomach a break when symptoms are worse

• Identifying and avoiding high-fiber foods that cause slow digestion

• Avoiding high-fat foods

• Filling up on nutritious foods first before eating empty calories5

Lifestyle Changes

While there is no cure for diabetic gastroparesis, making certain lifestyle adjustments can help you live well with the disorder.

Things you can do to help minimize gastroparesis’s effects on your life include:

• Losing weight if you are overweight

• Not lying down after eating

• Taking a walk after eating

• Talking with a mental health professional to help process living with a chronic condition5

Summary

Diabetic gastroparesis prevents the stomach from emptying its contents at a normal speed, causing a variety of symptoms, including abdominal pain, nausea, vomiting, and feelings of fullness early during a meal. Treatment for the disorder includes controlling blood sugar, medications, nutritional modifications, and lifestyle changes.

 Sources

National Institute of Diabetes and Digestive and Kidney Diseases. What is diabetes?

Bharucha AE, Locke GR, Murray JA. Gastrointestinal manifestations of diabetes. In: Cowie CC, Casagrande SS, Menke A, et al., editors. Diabetes in America. 3rd edition. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018 Aug. CHAPTER 27. 

National Institute of Diabetes and Digestive and Kidney Diseases. Gastroparesis.

National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of gastroparesis.

Krishnasamy S, Abell TL. Diabetic gastroparesis: principles and current trends in management. Diabetes Ther. 2018;9(Suppl 1):1-42. doi:10.1007/s13300-018-0454-9

Marathe CS, Rayner CK, Wu T, et al. Gastrointestinal disorders in diabetes. [Updated 2020 Jan 11]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. 

National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of gastroparesis.

Ihana-Sugiyama N, Nagata N, Yamamoto-Honda R, et al. Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors. World J Gastroenterol. 2016;22(11):3252-3260. doi:10.3748/wjg.v22.i11.3252