Gastroparesis - mild case, possible neuropathy

Does anyone know whether mild cases of gastroparesis and neuropathy are reversible?

I suspect gastroparesis because my post meal blood sugar rises sometimes a little and sometimes more after 2 and 3 hours. Does a very large or fatty meal do that?

The endo said that I could do the same thing, eat the same food, use the same dosage and get different numbers. This makes the management of the condition - matching carbs and insulin very difficult.

Gastroparesis is caused by damage to the vagus nerve which controls the emptying of the stomach into the rest of the digestive system. The delayed stomach emptying means that your food will not get digested and absorbed in a normal or timely fashion. If you are using insulin therapy, it can be quite challenging to time your insulin dose to match the time when the food actually gets released into the small intestine, digested and absorbed. In PWDs, gastroparesis is almost always due to having had persistent uncontrolled blood sugar levels and is a form of neuropathy. There are medications that can force emptying faster but dietary modifications are most often used.

You need to eat in a way that doesn’t overload your paralyzed stomach. Eat frequent (six or more per day) small meals. Because your stomach isn’t working well, you want to avoid over-working it. Sometimes chewing food extra thoroughly (in essence, pureeing or liquefying it in your mouth) before swallowing will improve its passage from the stomach into the small intestine. After eating, engage in a little activity such as taking a walk to keep things moving. Whatever you do, never lie down after a meal. You should also avoid raw (roughage) and fatty foods, both of which will slow down absorption. Drink lots of water and do not drink alcohol, juices or carbonated beverages.

If your results are not satisfactory, you may have to switch to a heavily liquid diet such as soups and blenderized mixtures. The success rate for those using dietary measures alone is mixed and will vary from person to person, depending on how strict they are in terms of compliance. You really should discuss this with your doctor. You might also try delaying the injection of insulin until after your meal instead of before and/or splitting your insulin dose into two or more injections separated by whatever time frame works best for you (requires trial and error; be sure to keep a log or diary to track the results).

Is it reversible? For diabetics, lowering your blood sugar levels into normal or safe ranges will often help reverse the condition over time. It won’t happen overnight but neither did you develop the problem overnight. It takes persistence, patience and time and the downside is, PWDs who allowed their blood sugar levels to persist at high levels over extended periods of time may not change their habits sufficiently to enable the body to heal itself. Some may have the desire and intent to do so but may have other health issues (such as cardiovascular disease) so that aggressive glucose-lowering may carry higher mortality risks. Discussing this with your doctor is still your best option.

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Is neuropathy reversible? Yes. However, it's not as simple and deterministic as reversing, say, high BP with treatment, which pretty much always works.

It depends on the many factors, and frustratingly one of them is simply variation from person to person. Some people, when neuropathy presents, never have any improvement despite getting tight BG control and keeping it. These people are in the worst situation, however for most diabetics getting BG under control will improve peripheral neuropathy, restore sensation, and in some cases resolve completely after consistent good control for months, up to a year. Maintaining control is critical to keeping the neuropathy at bay.

As NutriJoy notes, gastoparesis is caused by neuropathy in the vagus nerve. I don't know of any statistical or study data regarding improvement in gastoparesis with improved control, but it stands to reason that if the peripheral nerves can heal, the vagus nerve should be able to improve too. However, there may be differences that complicate that picture -- I just don't know.

Just bear in mind that nerves, if they recover from neuropathy, do so very gradually. There will be no "Big Bang" sudden restoration of feeling -- or functional digestion -- simply by getting BG in line. You've got to get it under control, and stay on top of it. Took my peripheral neuropathy a full year to resolve as much as it was going to (which was a lot). Rather than being delightedly surprised that my fingers were feeling properly again after seeing my numbers come down, it was more one of those things where, one day after about 6 months of good control, it occurred to me that I wasn't feeling the numbness, ulnar nerve issues, etc. any more. It was more like, "hey, I'm not constantly noticing that stuff any more".

Then I celebrated with a trip to Baskin Robbins with my kids :slight_smile: (really, I did! And a rather large Humalog bolus…)

It doesn't sound like you have gastroparesis to me. First of all, I think you have not had diabetes for very long, and as Nutrijoy said, gastroparesis is usually a complication of long-term uncontrolled high BG.

Second, a classic sign of gastroparesis is that your BG will go LOW after eating (which you didn't mention) because your insulin starts working before your stomach is able to empty into your intestines. In answer to your question, YES, a very large or fatty meal can cause BG to rise hours after eating, regardless of whether you have gastroparesis - so that may be what you are actually experiencing, having nothing to do with gastroparesis.

If you think you might have gastroparesis, then you should be tested for it. There is a non-invasive R/R interval test that is easily done at a doctors office.

Please explain what is meant by non-invasive R/R interval test. I looked quickly and the website mentioned

" your doctor can refer you to a cardiologist for an RR-interval study, or refer you to a neurology department where they can do autonomic function tests.

The RR-interval study is but one test used to evaluate gastrointestinal autonomic function. The RR-interval study is a simple indirect measure of vagus nerve function. The vagus nerve is principally responsible for controlling gut action and heart rate. Therefore, a finding showing that the heart is not responding correctly to normal physiological demands of breathing also indicates that the stomach function is compromised as well.

A normal heart rate varies with breathing. The heart normally speeds up with each inhalation, and then slows down significally with relaxed exhalation. In autonomic neuropathy, there is minimal-to-no variability in heart rate with inhalation and exhalation of a breath.

Performing the RR-interval study requires the patient to lie down, connected to an ECG heart monitor; the doctor coaches the patient though five-second patterns of inhalation and exhalation. The study is continued for a couple of minutes."

It's non-invasive because they don't need to puncture your skin - they just measure your heart rate with a couple sensors taped to your body. What could be simpler?

My podiatrist has started me on nerve testing for numb soles of my feet, one foot worse than the other. He injected high doses of Vit B,and an anti-inflammtory drug and told me to take benfotiamine 2X a day, plus Alpha lipoic acid tabs(both over the counter). He thinks the neuropathy an be decreased this way. So far ,t here is a mild improvement, no pain at the joints of the toes, as they connect to the foot. All other testing will be in the next 2 weeks.
I sometimes have 3 hour post meal highs, though I think I am bolusing for the correct # of carbs. Maybe a delayed bolus, but its hard to know if that particular meal will need that!
Such a guessing game this all is, with some good science, but its frustrating.