Monday, June 27, 2022

Stomach Pain and Type 1 Diabetes: What You Should Know

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Pain in or near the stomach can mean different things when it comes to type 1 diabetes (T1D).

This is one of the common symptoms of a new T1D diagnosis, and it’s one of the many symptoms that can develop quickly and become life threatening in those who are not yet diagnosed with this autoimmune condition.

But stomach pain can also occur in those already living with this T1D, from those experiencing dangerously high glucose levels to a serious medical emergency known as diabetes ketoacidosis (DKA)..

Additionally, a separate condition known as gastroparesis can also materialize for those with diabetes, causing stomach pain or bloating following a meal.

Approximately 1.6 million people in the United States are living with this autoimmune condition, which occurs when the body’s immune system attacks itself and the pancreas stops producing the hormone insulin.

Though many kids and teenagers are diagnosed, a T1D diagnosis can happen at any age. In fact, a 2022 study shows that adult-onset T1D is the most common and is often misdiagnosed as type 2 diabetes (T2D).

The most common signs of T1D include:

  • frequent need to urinate
  • extreme thirst
  • excessive hunger
  • unexplained weight loss
  • unusual fatigue
  • nausea and vomiting
  • stomach pain
  • blurry vision
  • bruises and cuts that take longer to heal
  • vaginal yeast infections

Another potentially life threatening complication from T1D is DKA.

When your body doesn’t have enough insulin to use in converting glucose into energy, it begins to break down fat instead. In response, your body releases ketones into your bloodstream, making your blood too acidic.

DKA can have a sudden and severe onset, and it needs to be addressed and treated with insulin immediately.

Symptoms of DKA include:

  • stomach or abdominal pain
  • nausea and vomiting
  • fruity-smelling breath
  • sleepiness or drowsiness
  • rapid breathing
  • confusion
  • loss of consciousness

Again, DKA is a medical emergency and left untreated can lead to coma and eventually death.

Those who are undiagnosed may experience DKA suddenly, without realizing what’s happening.

But those who already live with this autoimmune condition can also develop DKA. That may occur if the person is not getting enough insulin. For example, if their insulin pump breaks or isn’t delivering insulin into the body as it should.

Gastroparesis is a frequent problem that many people with T1D experience.

Some research suggests that as many as 40 percent of those with T1D may experience gastroparesis, while 30 percent of those living with type 2 diabetes may have this condition.

Also known as chronic delayed gastric emptying, gastroparesis is essentially a digestive disorder in which the stomach muscles malfunction and slow down the rate at which food moves from your stomach to your intestine.

Gastroparesis can cause a number of unpleasant symptoms, too. Those include:

  • nausea
  • bloating
  • vomiting
  • being overly full after eating
  • feeling full much sooner than you’d expect to feel when eating

Depending on its severity, gastroparesis can create a significant impact on your quality of life.

In order to diagnosis gastroparesis, you’ll need to check with your doctor or healthcare team.

Your doctor will perform a physical exam and ask you questions about your medical history. In order to rule out other possible causes of your symptoms, your doctor will probably want to run some tests. These might include an ultrasound or upper endoscopy procedure, to rule out other conditions and health issues that might be impacting your stomach.

Once your doctor has ruled out other possible causes of your symptoms, they’ll order tests to evaluate how well your stomach empties. This test may include a gastric emptying scan, which involves eating a small amount of food with a harmless radioactive substance. By doing so, your doctor can see how fast food is being digested and emptied from your stomach.

Once diagnosed, you can begin treatment.

And it can interfere with nutrient absorption, which could lead to malnutrition over the long term. And it can interfere with nutrient absorption, which could lead to malnutrition over the long term.

Gastroparesis does not have a cure. But it can be managed.

Here are some ways that you and your healthcare team can treat gastroparesis:

  1. Your doctor may start by recommending that you make a few changes to your diet, which may actually be enough to solve your problem. You can start by eating frequent small meals, rather than just a few large meals. Aim for eating more soft foods that are easier to digest.
  2. Eating fat and fiber can slow the process of your stomach emptying, making the situation worse. Try and reduce your fat intake so that it doesn’t exceed 25 to 30 percent of your daily calorie intake.
  3. Another strategy: Make sure you don’t eat more than 15 grams of fiber per 1,000 calories..
  4. Experts also suggest making sure you drink plenty of water. The Centers for Disease Control and Prevention (CDC) suggests 6 to 10 cups of water per day for most adults.

However, dietary changes may not be enough.

Your doctor may recommend medication to improve gastric emptying or reduce nausea, such as the following:

  • Metoclopramide. This is a commonly used gastroparesis drug approved by the Food and Drug Administration (FDA). It stimulates movement in your stomach and gut while relieving symptoms like nausea and vomiting. It belongs to a category of drugs called prokinetics, several of which have been used to successfully manage gastroparesis.
  • Antiemetics. This type of medication may also help reduce nausea and vomiting.

Your doctor may also review any medications that you’re taking that could be contributing to the problem. For example, some drugs can slow down the process, including:

  • opioid painkillers
  • H2 receptor agonists
  • proton pump inhibitors
  • tricyclic antidepressants
  • antihistamines
  • benzodiazepines
  • calcium channel blockers.

People who don’t respond well to medications could be candidates for other types of treatment. That may involve procedures such as gastric electric stimulation or gastric neuromodulationwhich stimulate your GI system and improve symptoms.

In severe cases, some people may need to turn to enteral nutrition. This essentially means liquid nutrition but it can also mean feeding through a tube that’s inserted in your stomach or small intestine. A surgeon can perform a gastrostomy, which is a procedure that creates. an opening for the placement of a feeding tube.

If you’re struggling with gastroparesis, your doctor may also suggest a review of your diabetes management strategy.

For example, normally you might take insulin about 15 to 20 minutes before eating a meal. This is known as pre-bolusing, which allows insulin to enter the bloodstream before food enters your body and begins raising your glucose levels.

If your stomach empties slowly and nutrients take longer to be absorbed, you may need to adjust the timing of when you take insulin before a meal.

Using an insulin pump and a continuous glucose monitor (CGM) may also be able to help you maintain control over your blood glucose levels.

Stomach pain could be a sign of undiagnosed T1D or it could be a symptom of high blood sugars or even a dangerous DKA emergency. For those who have been diagnosed with T1D, stomach pain could be a sign that certain diabetes management aspects need review by your healthcare team. Many people with diabetes also experience gastroparesis that can cause stomach problems, and while it’s uncurable, this condition can be managed with different eating or drinking behaviors, as well as medications or other medical procedures.

Discuss your concerns with your doctor or diabetes care team to determine what potential solutions to your stomach issues might work best for you.

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