Hello, I am a 52 year old Type 1 diabetic, diagnosed aged 37, running on a basal/bolus regime with partial success.
I have (and have always had) a problem with slow digestion and a recent DAFNE and Carb Counting course has highlighted how this causes me problems for maintaining good control.
Every few days I suffer from constipation. I will go a couple of days without passing anything. When this happens my levels run unfailingly high, as if the baseline has moved up by 4 or so mmol. Bolus insulin becomes less effective. I also get light stomach cramps. I need to go but can’t.
Then things get back to normal and for a couple of days I’m fine. This repeats every few days. If I have a large meal (a dinner out for example) then this will almost immediately cause the problem.
Running or a brisk walk does help relieve the symptoms.
As soon as I manage to empty my bowels, my numbers drop almost immediately.
It has been suggested that this is gastroparesis, but I’ve not had tests for this. I am willing to experiment with changing my diet somewhat. I only eat around 50-70g carb per day and I’m pretty active.
What does the panel think (and apologies for my first new post being about bowels).
Gastroparesis is a fairly common complication of long-standing diabetes. The main presenting symptom that patients report is a feeling of extreme fullness during or after eating. It is caused by the degeneration of nerves governing gastric motility. Its course can be irregular, progressing and then remitting, and at its worst it can require the patient to be fed only through a j-tube to avoid starvation.
It can be treated by the drug domperidone, though because of some alarmist studies in England, many physicians are now reluctant to prescribe it at all, or to prescribe it in adequate doses. It is now even banned in the United States, though available in Canada, the Caribbean, and several European countries, and some American patients travel to these countries every month to get their allowed one-month supply of the drug to bring back. I think this is absurd, because there have so far been zero deaths reported in North America from patients using even large doses of the drug.
Some research work is now going on to see if implanting an electrical stimulation device can work to improve gastric nerve function, but so far this has not yielded much benefit.
Dr. Richard Bernstein makes the following suggestions:
"Exercises That Facilitate Stomach-Emptying
The paretic stomach may be described as a flaccid bag, deprived of the rhythmic muscular squeezing present in a stomach that has a properly functioning vagus nerve. Any activity that rhythmically compresses the stomach can crudely replicate normal action. You may perhaps have observed how a brisk walk can relieve that bloated feeling. I therefore strongly recommend brisk walking for an hour immediately after meals — especially after supper.
“A patient of mine learned a trick from her yoga instructor that eliminated the erratic blood sugar swings caused by her moderate gastroparesis. The trick is to pull in your belly as far as you can, then push it out all the way. Repeat this with a regular rhythm as many times as you can, immediately after each meal. Over a period of weeks or months, your abdominal muscles will become stronger and stronger, permitting progressively more repetitions before you tire. Eventually shoot for several hundred repetitions — the more the better. This should require less than 4 minutes of your time per hundred reps, a small price to pay for an improvement in your blood sugar profiles.”
It works for me.
Dr. Bernstein has developed a rather elaborate alternative treatment program for gastroparesis involving exercises and massage because he did not like the fact that taking more than 20 mg a day of domperidone will destroy the libido, since it raises prolactin levels. (It was originally developed as a drug to promote lactation in women.) But if you don’t mind losing your libido, taking domperidone pills is a lot easier.
I would get a definitive diagnosis before I started self-treating for gastroparesis. In the meantime, have you tried some simple diet changes: less dairy/cheese/eggs, more fiber (in the diet vs supplemental), drinking more water?
I have another consultants appointment in April and hope to have more luck than the last one. At the last appointment the consultant said I had GP but didn’t perform any tests. I later learn’t that she has been struck off so I’m not sure the advice was 100% reliable.
After reading a bit more I’m noticing I don’t have any nausea, which seems to suggest that perhaps it’s not GP. I will, of course, not change any medication until I’ve had a proper diagnosis, though I have been trying to get a proper diagnosis for several years.
Thanks to everyone for the fullsome replies. I have decided to trial a couple of elimination diets, for 14days at a time, to see if it’s something in my diet causing the problem. So from today I’m avoiding Casein, so no hard cheese, yoghurt, cream).
@willow4 I may try the exercises anyway as this tallies with my experience of a brisk walk or run helping the condition. I have Bernstein’s book on the shelf but always forget to refer back to him, so thanks for the nudge.
The gold standard test for gastroparesis is to consume a meal labeled with barium, which then allows the progress of the meal through the stomach and intestines to be traced and timed, so that any delays become evident. It is a time-consuming process, but it will definitively settle whether you actually have gastroparesis.