Thursday, July 24, 2014

The "Quirks" of Diabetes Complications- Part I, Gastroparesis

Most people, when they think of diabetes complications, think of the BIG ones. It is well documented, researched and understood that diabetics face challenges with their health. Many people realize that diabetes causes heart disease, blindness, kidney failure, limb amputations nerve damage and stroke. 
However, there are a host of other "complications" that diabetes causes. While these complications may not be life-threatening, they do reduce the quality of life a diabetic has. These smaller complications may not be as traumatic as a heart attack and you may be able to still participate in parts of life but they are complications. They are frustrating, they are signs that your diabetes is weakening, they may come on long before the "big ones" but these early, complications are saying that your diabetes is breaking down your body. 
I want to share with you some of the quirky complications that long term (20+ years) Type 1 Diabetics may start to suffer. Some of these may also show up in Type 2 Diabetics and may show up sooner because Type 2 can advance more quickly but that's a different discussion.
Realize that both Type 1 and Type 2 can cause complications and the better you get at monitoring and correcting high blood sugars the better off your life will be and the longer you will LIVE. Since there are several "quirky" complications I will only go through one or two a day. Some of them will have longer explanations than others. Today I will focus on Gastroparesis, damage to a nerve that aids in digestion.
  • Gastroparesis is a condition in which the muscles in your stomach don't function normally.
  • Ordinarily, strong muscular contractions propel food through your digestive tract. But in gastroparesis, the muscles in the wall of your stomach work poorly or not at all. This prevents your stomach from emptying properly.
Gastroparesis is a rough condition to have. It's usually diagnosed via a colonoscopy. It doesn't get better, even with proper diabetes care. Once you have it, it is almost impossible to reverse. It is caused by damage to the vagus nerve.
  • The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested.
  • Signs and symptoms of gastroparesis include:
  • Vomiting
  • Nausea
  • A feeling of fullness after eating just a few bites
  • Abdominal bloating
  • Heartburn or gastroesophageal reflux
  • Changes in blood sugar levels
  • Lack of appetite
  • Weight loss and malnutrition
 Gastroparesis may sound cool because you can lose weight on it and you often can't stomach much food because your stomach feels so blown up. However, once weight loss starts it means the gastroparesis is very far advanced. Before that time, your stomach just feels extremely hard and full for MANY hours after eating. No matter how small a meal you eat, the gastroparesis damage will cause you to feel full.

For diabetics that can be dangerous because if you take your insulin and aren't able to eat the full amount of food that you took insulin for, your blood sugar can drop to dangerous lows. Gastroparesis also makes you feel awful. It can be hard to walk after eating; eating on top of drinking something often causes more pain. Utilizing just pureed foods and soups for meals can also make eating easier but this gets boring fast! This feeling of fullness lasts until it's pretty much time to eat again and then you have many more hours of feeling bad again. If your blood sugar goes low in between meals it can be painful to eat again, thus causing a life-threatening situation. 

It can help to eat small meals, several times a day. However, for some diabetics, work and school schedules don't allow this. Thus, gastroparesis is a real threat. The food sitting in the stomach for too long after eating is serious because that means your body isn't getting the nutrients it needs at that time. It's sits there for too long before being digested and then it releases those sugars into the body LONG after you've taken your insulin thus possibly causing HIGH blood sugars long into the day.  Some of the issues encountered with Gastroparesis include: 
  • Bacteria overgrowth in the stomach. Food that stays in the stomach can begin to ferment and disrupt the balance of good and bad bacteria. This can allow harmful microorganisms to grow out of control.
  • Undigested food that hardens and remains in your stomach. Undigested food in your stomach can harden into a solid mass called a bezoar. Bezoars can cause nausea and vomiting and may be life-threatening if they prevent food from passing into your small intestine.
  • Blood sugar fluctuations. Although gastroparesis doesn't cause diabetes, inconsistent food absorption can cause erratic changes in blood sugar levels, which make diabetes worse. In turn, poor control of blood sugar levels makes gastroparesis worse.
There are medications to assist with some of the effects of gastroparesis; however, they don't always work. Medications to treat gastroparesis may include:
  • Medications to control nausea and vomiting. Anti-emetic medications include prochlorperazine (Compro), diphenhydramine (Benadryl, Unisom) and lorazepam (Ativan).
  • Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin. There is a risk of serious side effects with these medications, so discuss the benefits and risks with your doctor. 
I took Reglan for many months and found no relief. The side effects from Reglan were so serious that I opted to not try it again. Reglan is considered a "black box" drug for the US FDA and causes the following: 
  • Tardive dyskinesia- is a disorder that involves involuntary movements. Some of these movements are: Facial grimacing, Finger movement, Jaw swinging, Repetitive chewing, Tongue thrusting. This can be a permanent disorder. 
  • Symptoms associated with Parkinson's disease
  • Seizures or convulsions.
  • Anxiety, restlessness, agitation and sleep difficulties.
  • Suicidal thoughts/tendencies
  • Constipation and diarrhea
  • Loss of bladder control
  • Symptoms associated with liver disease, including nausea, vomiting, dark urine and jaundice
  • Fever, sore throat and chills
  • Dizziness and vision changes
I didn’t feel that these side effects were worth the relief, since I wasn’t getting any. I find that as time goes on I have more issues with the Gastroparesis. Many times I’m full before I’m halfway done with a simple meal. I suffer from nausea almost every day and vomit during the night at times.
At times I will sit and rub my stomach just to try and get the food to pass. For me the gastroparesis hits at once. I’ll be fine eating my dinner, thinking I’m doing okay, I haven’t eaten too much and then all of sudden I’m hit in the gut! It feels like my stomach is going to explode and I’ve eat half a sandwich. When there is big buffet or family style meal offering lots of choices I have to take incredibly small portions and pick the ones that are my favorite because I won’t be able to eat much. I know that certain foods make it worse and cause more pain than others. I know that splitting my lunch into ‘two meals’ one at noon and then another at one o’clock makes it better. However, due to my job duties this isn’t always possible. I know that drinking a diet soda with my meal is a bad idea. I know that pasta takes an incredibly long to pass through and that my blood sugar will be very high 8 or 10 hours after I eat rather than the usual 2-4 for most diabetics.
I am careful with what I eat. I make conscious choices about what to eat, how to eat it, how much of it too eat or drink. It’s not easy though. While this isn’t a disease that will kill me, it does progress to the point where you may not be able to eat solid foods at all and could need a feeding tube or dangerous surgery. I hope it doesn’t get to that level for me. As of right now I know that it has progressed in recent years but that is expected with everything I’ve been through.
The best way for a diabetic to avoid this complication is too maintain those ‘normal’ blood glucose levels and watch your A1C closely. This complication does take years for onset but it is painful and it is one of the more serious complications. It is hard to live with and can drastically alter your daily life.
Tomorrow I’ll try to focus on some complications you may not have even realized could be caused by diabetes! Fun times ahead, tune in!!!!!
As always Live, Laugh, Love!

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