Gastroparesis: Approaches to Controlling Gastroparesis

from Dr. Bernstein’s book “Diabetes Solution”
© 2007 by Richard K. Bernstein, M.D.

It is worth noting that gastroparesis can be cured by extended periods of normal blood sugars. I’ve seen several relatively mild cases where special treatment was terminated after about 1 year, and blood sugar profiles remained flat thereafter. At the same time, R-R studies improved or normalized. Since my late teens, I experienced severe daily belching, and burning in my chest. These symptoms gradually eased off, and eventually disappeared, but only after thirteen years of nearly normal blood sugars. My last R-R study was normal. The “sacrifices” in lifestyle required for treatment of gastroparesis may really pay off months or years later. The vagus nerve doesn’t control only stomach emptying—there are a number of other complications resulting from impaired vagus function that can be reversed by maintaining normal blood sugars. The regained ability to sustain a penile erection is an important one for many of my male patients.

Once gastroparesis has been confirmed as the major cause of high overnight blood sugars and wide random variations in blood sugar profiles, we can begin to attempt to control or minimize its effects. If your blood sugar profiles reflect significant gastroparesis, there is no way to get them under control by only juggling doses of insulin. There’s just too much danger of either very high or very low blood sugars for such approaches to work. The only chance for effective treatment is to concentrate on improving stomach-emptying.

How do we do this?
We have four basic approaches. First is the use of medications. Second is special exercises or massage during and after meals. Third is meal plan modification utilizing ordinary foods, and fourth is meal plan modification utilizing semiliquid or liquid meals. It’s unusual for a single approach to normalize blood sugar profiles fully, so most often we try a combination of these four approaches, adapted to the preferences and needs of the individual. As these attempts start to smooth out blood sugars, we must modify our doses of insulin or ISAs accordingly.

The guidelines that we use to judge the efficacy of a given approach or combination of approaches are these:

  • Reduction or elimination of physical complaints such as early satiety, nausea, regurgitation, bloating, heartburn, belching, and constipation
  • Elimination of random postprandial hypoglycemia
  • Elimination of random, unexpected high fasting blood sugars—probably the most common sign of gastroparesis that we encounter
  • Flattening out of blood sugar profiles

Remember that the last three of these improvements may not be possible even without gastroparesis if you’re following conventional dietary and medication regimens for “control” of your blood sugar. For example, I know of no way that will truly flatten out blood sugar profiles if you’re on a high-carbohydrate diet and the associated large doses of insulin.