Diabetic Gastroparesis medications & treatments
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Gastroparesis is an uncommon condition that affects around 10 men and 40 women out of 100,000 people. Uncontrolled diabetes mellitus is the most common cause of gastroparesis, contributing to about 33% of cases. It is more commonly seen in people with type 1 diabetes, although people with type 2 diabetes can also get it. Gastroparesis is more common in females than males. You are also more likely to develop this condition if you’ve had surgery around your esophagus, stomach, or small intestine.
What is diabetic gastroparesis?
Diabetic gastroparesis is a neuropathic complication of diabetes characterized by delayed gastric emptying that is not due to a gastrointestinal (GI) obstruction. Uncontrolled hyperglycemia can cause damage to the nerve (vagus nerve) that moves food through the digestive tract. This causes food to remain in the stomach longer than normal.
Diabetic gastroparesis causes
Although the exact cause of gastroparesis is often not known (idiopathic gastroparesis), certain risk factors that increase your chance of developing this condition include:
- Type 1 diabetes
- Type 2 diabetes for more than 10 years
- Surgery to your esophagus, stomach, or small intestine
- Thyroid dysfunction (hypothyroid)
- Autoimmune diseases such as scleroderma
- Nervous system disorders such as Parkinson’s disease
- Viral infections
- Certain medications such as opioids
How is diabetic gastroparesis diagnosed?
To confirm a diagnosis of gastroparesis, your doctor or healthcare professional will look at your symptoms, review your medical history, perform a physical exam, and run some tests.
Diabetic gastroparesis symptoms
The most common symptoms of gastroparesis include:
- Acid reflux
- Vomiting undigested food
- Loss of appetite
- Weight loss
- Abdominal pain
- Early satiety (feeling full with a small meal)
- Trouble controlling blood glucose levels
The American College of Gastroenterology recommends that a documented delay in gastric emptying is required for the diagnosis of gastroparesis. Your healthcare provider may use several tests to help confirm your diagnosis or rule out other conditions that may be causing your symptoms, including:
- Scintigraphy. This test measures the rate at which your stomach empties. In this procedure, you eat a light meal that contains a small amount of a radioactive compound. A scanner is used to follow the food and determine the rate at which it leaves your stomach.
- Upper gastrointestinal (GI) endoscopy. This test is performed using a thin, flexible tube that has a tiny camera (endoscope) to examine your upper digestive tract for any abnormalities. It can also be used to rule out other conditions with similar symptoms such as gastric ulcers, pyloric stenosis, and GI obstructions.
- Breath tests. This test involves eating food that contains a substance that can eventually be detected in your breath. Your doctor will collect breath samples over several hours and measure the amount of the substance present to determine how fast your stomach empties.
- Wireless motility capsule (SmartPill). The SmartPill is a small electronic device that is swallowed and passed through your digestive tract. It records data that can help your doctor determine how quickly your stomach empties. The capsule will pass naturally through a bowel movement.
- Barium X-ray. Your doctor may order this test to rule out other conditions such as an obstruction. You will drink a barium solution after fasting for 12 hours and then have an X-ray of your stomach. If you have gastroparesis, food will be visible in your stomach.
- Imaging tests. Imaging tests such as ultrasound may be performed to rule out other conditions (kidney disease, pancreatitis) as causes of your symptoms.
What are some diabetic gastroparesis treatment options?
Frequent monitoring and managing of blood sugar levels are important parts in the treatment of gastroparesis. There are several treatments available your doctor may recommend to help manage symptoms and reduce the risk of complications.
Your doctor may prescribe the following medications that help move the food through your digestive tract or to help manage symptoms such as nausea and vomiting:
- Reglan (metoclopramide). This medicine is a prokinetic agent that increases the muscle contractions in the wall of your stomach to improve gastric emptying and reduce nausea and vomiting.
- Domperidone. This medicine works similarly to metoclopramide to help move food through the digestive tract. It is currently only available through an expanded access program through the U.S. Food and Drug Administration (FDA).
- Ery-Tab (erythromycin). This macrolide antibiotic is used off-label to increase stomach muscle contraction to increase the rate at which your stomach empties.
- Antiemetics. Antiemetics, such as Phenergan (promethazine) and Zofran (ondansetron), may be prescribed for symptomatic relief of nausea and vomiting. They will not improve gastric emptying.
- Antidepressants. Antidepressants, such as Remeron (mirtazapine) can help relieve nausea and vomiting.
Healthy eating habits
Adequate nutrition is also an important part of the treatment of diabetic gastroparesis. Changing your eating habits can help manage your gastroparesis and prevent complications such as malnutrition. Your doctor may recommend that you:
- Eat 5 or 6 small meals throughout the day
- Eat low-fat foods
- Drink plenty of fluids that contain electrolytes
- Eat well-cooked, soft foods
- Limit or avoid high-fiber foods as they can cause bezoars (solid mass of undigested food)
- Avoid alcohol and carbonated drinks
- Avoid laying down for 2 hours after a meal
- Take a walk after eating to promote digestion
If you cannot tolerate oral nutrition, your doctor may recommend an oral or feeding tube. This is done by putting a tube into your mouth or nose, through your esophagus and stomach, and into your small intestine. If this doesn’t work or you need a long-term solution, your doctor may opt to place a jejunostomy tube. To place it, your doctor will create an opening in your abdominal wall and into your small intestine (jejunum). This will bypass your stomach and deliver nutrients and calories directly to your small intestine.
If you have a severe case of diabetic gastroparesis that has failed other treatments, your doctor may give you intravenous (IV), or parental nutrition. Parenteral nutrition bypasses the usual process of eating and digestion to deliver nutrients and calories directly into your bloodstream.
This procedure is used to relieve pressure inside your stomach. Your doctor will create an opening through your abdominal wall and into your stomach. A venting G-tube is then placed through the opening to remove air and drain fluids out of your stomach. This can help relieve nausea, vomiting, and bloating.
Gastric electrical stimulation
Gastric electrical stimulation (GES) uses a battery-powered surgically implanted device to electrically stimulate your stomach muscles to help move the food down the digestive tract. It is typically only used in people whose symptoms can’t be controlled with medications.
Botulinum toxin has been shown to improve gastric motility by decreasing the contractions of the muscle between the stomach and the small intestine (pyloric sphincter).
What is the best medication for diabetic gastroparesis?
The best medication for the treatment of diabetic gastroparesis will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with diabetic gastroparesis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter diabetic gastroparesis medications approved by the Food and Drug Administration (FDA).
Best medications for diabetic gastroparesis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects
|Reglan (metoclopramide)||Prokinetic agent||Oral||10mg every 6 hours 30 minutes before meals and at bedtime.||Involuntary muscle contractions, fatigue, restlessness, drowsiness, headache, dizziness
|Domperidone||Prokinetic agent||Oral||10mg to 30mg 4 times a day.||Headache, increased heart rate, diarrhea
|Ery-Tab (erythromycin)||Motilin agonists||Oral||250mg to 500mg 3 times daily before meals.||Stomach pain, nausea, diarrhea, vomiting, indigestion
|Zofran (ondansetron)||Selective 5-HT3 antagonist||Oral||4mg to 8mg three times daily.||Headache, fatigue, constipation, drowsiness, diarrhea, dizziness
|Zofran ODT (ondansetron)||5-HT3 receptor antagonist||Oral dissolving tablet||Dissolve 1 tablet (4mg to 8mg) on the tongue 3 times daily.||Headache, fatigue, constipation, drowsiness, diarrhea, dizziness
|Compazine (prochlorperazine)||Phenothiazine||Oral||5m to 10mg every 6 to 8 hours.||Restlessness, dizziness, headache, blurred vision, dry mouth
|Trilafon (perphenazine)||Phenothiazine||Oral||8mg to 24mg per day divided every 6 to 12 hours.||Restlessness, muscle stiffness, tardive dyskinesia, drowsiness, dry mouth
|Antivert (meclizine)||Antihistamine||Oral||25mg to 100mg per day divided every 6 to 12 hours.||Drowsiness, constipation, headache, dry mouth, fatigue
|Phenergan (promethazine)||Antiemetic||Oral||12.5mg to 25mg every 4 to 6 hours as needed.||Drowsiness, confusion, blurred vision, dry mouth, low heart rate
Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of diabetic gastroparesis medications?
As with all medicines, those used for diabetic gastroparesis will have some side effects, depending on the class you are taking:
- Prokinetic agents such as Reglan (metoclopramide) and domperidone can cause involuntary muscle contractions, fatigue, restlessness, drowsiness, headache, and dizziness.
- Ery-Tab (erythromycin) commonly causes stomach pain, nausea, diarrhea, vomiting, and indigestion.
- Antiemetics may cause headache, fatigue, dry mouth, constipation, drowsiness, diarrhea, dizziness, blurred vision, and restlessness.
What are some home remedies for diabetic gastroparesis?
If you have diabetes, the best way to prevent gastroparesis is to keep your blood sugar levels within the target range set by your healthcare provider.
Diabetic gastroparesis prevention
Some lifestyle and dietary changes that can prevent or relieve symptoms include:
- Eat small, low-fat meals 5 or 6 times a day
- Try more liquid foods such as soups or pureed foods
- Chew solid food thoroughly before swallowing
- Drink plenty of water
- Avoid high-fiber foods
- Quit smoking
- Avoid alcohol, coffee, and carbonated drinks
- Don’t lie down for 2 hours after eating
- Get regular exercise
- Walk after meals
- Chew gum after meals
Frequently asked questions about diabetic gastroparesis
What are some complications of diabetic gastroparesis?
If not treated properly, diabetic gastroparesis can decrease your quality of life and cause complications such as:
- Bezoars (hardened undigested food in the stomach)
- Uncontrollable blood glucose levels
Can diabetic gastroparesis be cured?
Diabetic gastroparesis can be successfully managed with medications, lifestyle, and dietary changes. If you keep your blood sugar levels within a normal range, you should see your symptoms improve or resolve.
What foods and drinks should you avoid if you have diabetic gastroparesis?
Certain foods and drinks may worsen gastroparesis symptoms and you should try and avoid them. These include:
- Fatty foods
- High-fiber foods
- Raw fruits and vegetables
- Nuts and seeds
- Beans and legumes
- Carbonated drinks
What medications should you avoid with diabetic gastroparesis?
Certain medications can delay gastric emptying and should be avoided with gastroparesis, including:
- Calcium channel blockers
- Tricyclic antidepressants
- Dopamine agonists, which are used to treat Parkinson’s disease
- Glucagon-like peptide-1 agonists, which are used to treat type 2 diabetes
- Sandimmune (cyclosporine)
Related resources for diabetic gastroparesis
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.