By Melinda Maryniuk, MEd, RD, CDCES
High blood glucose caused by diabetes can damage our nerves over time. You may have heard about neuropathy (or nerve damage) of the feet –stomach nerves can also be affected. Gastroparesis is a condition where the nerves of the stomach are damaged and it can affect how food is digested. It is more common in people who have had diabetes for a long time. If you have gastroparesis, you may feel:
Very full or bloated after eating very little food.
The food you eat may sit longer in your stomach before it is moved into the intestines for digestion. Because digestion is often delayed, this can make your blood glucose rise (and fall) very unpredictably. It can make it very difficult to keep glucose levels in your target range. The important thing to know is that this isn’t your fault!
What to do?
Talk with your doctor: If you have any of these symptoms, particularly if you’ve had diabetes for many years, talk about them with your doctor so it can be determined if you might have gastroparesis. Treatment usually includes both medicines and some diet changes.
Check blood glucose more often: Check several times after meals to get a better understanding if when food is being digested and getting into your bloodstream. See if any patterns emerge. For example, does a meal higher in fat and protein have a much later glucose rise than a meal higher in carbs?
Adjust or add medicines: Talk to your doctor to learn if you need to make some changes with your diabetes medicines in terms of the amount (dose) or timing. For example, meal time insulin may work better if given just after the meal to allow for the delayed digestion. Many people who use meal time insulin find moving to an insulin pump gives them more flexibility.
There are also some medicines that help stimulate the stomach muscles to help with digestion including metoclopramide, erythromycin and domperidone. There are also medicines that can help you with feelings of nausea, if that is a problem for you.
Adjust what and how often you eat. The best way to adjust your diet to ensure you are well-nourished, comfortable and have stable blood glucose numbers is very individual. It is best to work with a dietitian and your doctor to figure out the best plan for you. Here are some general guidelines:
Many people do better with smaller, more frequent meals. Try eating small meals 5-6 times a day.
Chew food well. Eat slowly.
Typically foods that are lower in fiber and lower in fat are better tolerated. White, refined grains are better tolerated than whole wheat. Choose lower- fat meats and dairy foods.
Limit the fiber in fruits and vegetables by peeling them or cooking them well.
Avoid carbonated beverages, alcohol and smoking.
Try more soft foods and soups. For more serious symptoms, you might find liquid meals (such as a meal replacement shake) are helpful.
Try taking a gentle walk after a meal; avoid lying down for 2 hours after eating.
Take a multi-vitamin to help ensure you get the nutrients you need.
Foods that are usually better tolerated include foods that are soft, well cooked and easily digested (low in fiber and fat) including:
Eggs, flaky fish, peanut butter, tofu
Low fiber cereals, white bread, white rice and pasta
Fruit purees, applesauce, bananas
Well cooked, lower fiber vegetables (such as zucchini)
Milk, yogurt (low-fat)
Foods that are usually less well tolerated include high fiber grains and veggies, nuts, seeds and fattier meats and other high fat foods including:
Beans and legumes
High fiber veggies: asparagus, corn, peas, broccoli, cauliflower
High fiber whole grains: whole wheat, brown rice, whole grains (farro, quinoa, etc)
Nuts and seeds
Full-fat dairy and fats/oils: heavy cream, cheese, butter and oils
Alcohol, carbonated beverages