Complications - gastroparesis.

Thanks to Caro for her comment on my first post. This has given me a subject for today's post - gastroparesis.

What is gastroparesis?
Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. It often occurs in people with type 1 diabetes or type 2 diabetes. Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped. Diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. (Follow the link above for more information).

The first symptoms I had were unexplained bouts of vomiting. As it was only about once a year I didn't really think too much about it. I did mention it at a diabetes clinic visit but I was told it could be anything and not to assume that any illnesses I had were necessarily caused by having diabetes. When I had had 2 bouts a few months apart, I mentioned it again, and it was suggested that I go for a gastric emptying test. This couldn't be done at my local hospital so I had to get up early and get a train 20 miles to Liverpool for an 8.30am appointment. I had to fast from the evening before.

On arrival I was seated in front of a large machine which was going to track the food I was about to eat for the next 2 hours. I had to take my insulin and then because the machine was in front of me and I couldn't feed myself, I was spoonfed some porridge, then a sandwich and had to drink a cup of tea through a straw. Most undignified!! All of this was laced with a radioactive substance which would be tracked. I then had to sit still for 2 hours or so. A nurse was with me and basically we just chatted.

The results were that my stomach was emptying slower than it should do. As it was very infrequent, no treatment was suggested apart from tightening up my blood sugars. I think I had that test about 5 or 6 years ago. I continued to have bouts of vomitting lasting a couple of days each, about twice a year, and was given Domperidone which speeds up the activity of the stomach.

The episodes of gastroparesis can occur quite spontaneously. Usually I wake in the early hours of the morning feeling very hot and with what I call "eggy burps" - an awful sulphurous taste. This is caused by undigested food starting to go off in my stomach. A few minutes later I throw up. Now, these episodes are easy to handle as there is no "active" insulin in my system at that time of day, just the basal amounts from the pump. I just don't eat for the rest of the day, check bgs often, keep up fluids - just water usually and sometimes that doesn't stay in! - and wait until it all calms down. I may throw up a few times during the day but eventually it stops. It then takes a couple of days to stop feeling like I've been kicked in the stomach, and then I'm back to normal.

I went onto the pump in August 2004 and it seemed that I was only getting an episide once a year. In March this year I had a different episode. I'd woken up with a bg of 9 (not unusual for me - I am usually running high) and had my insulin and breakfast as usual. About an hour later I felt something wasn't right, and checked my bgs - 8. As they usually shoot up after breakfast I kept an eye on them, and watched as they dropped to 6 in the next half an hour. I guessed something odd was going on and took some Lucozade. The bgs dropped again. More Lucozade and Glucostop, but they kept dropping. At 4.2 we decided to pop over to A&E. By the time I got there, I was shaking and very weak, and was taken straight through and given some toast and jam. It was about another 20 minutes before my bgs were checked, and of course they had started to rise. I started to feel a bit daft, but I am prone to panic when my bgs drop.

I had various bloodtests done and a chest Xray to try to find out what had caused it, and the conclusion was that I had recently had an undetected chest infection. (But I thought infection raised the blood sugar?) I was given antibiotics and sent home after 4 hours. By now my Bgs were 18. The gastroparesis then kicked in and I had my usual vomiting for the rest of the day.

In May I had another early morning episode, but I am now shaken up and expecting it to happen any day at any time. I keep thinking that if my bgs had started off at 4 and had dropped and the glucose hadn't worked I would have gone unconcious. I have never gone unconcious before and this is a really scary thing for me. I am therefore checking bgs, then eating and waiting to check the bgs are rising before I take my bolus. By the time it kicks in, the bgs are far too high into the mid-teens but at least I am nowhere near a hypo.

I now take a Domperidone every morning, and I have been given a prescription for Erythromycin which also encourages stomach activity but I haven't taken them yet. The thing is that between episodes my stomach works absolutely fine and it is only now and again that it doesn't. So I don't want to be taking a long term antibiotic if I don't have to.

I am currently running blood sugars of 10-14 all the time, which I KNOW isn't a good idea. Ggggrrrrrrrrrrrrrrrrrrrrrrr!!!!