by Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S.
October 2001
Diabetes Interview
I have gastroparesis and type 1 diabetes. I would like to know what I can do to control my blood sugars and keep from getting bloated. I am on the pump and cannot accurately predict the effect foods have on my body. I also seem to have a bad problem with bloating. I can go from a size five to a 10 in one day. Ryan Tyler-Ramirez, Carpinteria, California
Gastroparesis, or a partially paralyzed stomach, is commonly found in people with diabetes who have experienced elevated blood sugars for a number of years. In advanced stages, it can cause symptoms such as early satiety and bloating, nausea and vomiting. In the early stages, it is only discernable by its erratic effects upon blood sugar due to unpredictable stomach emptying.
Castroparesis is very difficult to treat, but it can be rendered less severe by a number of measures used simultaneously.
Since you appear to have a relatively advanced condition, severe dietary intervention is warranted. This incluAes a very low-carbohydrate diet with total elimination of high-fiber vegetables such as salads; broccoli, etc. Protein foods should be limited to fish, eggs, cheese and ground meats. Evenrbetter would be a liquid or semi-liquid diet such as baby food and drinks made from egg-white protein.
There are a number of other approaches to speeding stomach emptying that should be used in addition to the dietary changes. These include drinking two glasses of water with each meal, taking certain digestive enzymes while eating, doing special exercises and chewing gum after meals, etc. Although there are some medications that can improve stomach emptying, none of them are effective for advanced cases like yours. An especially effective enzyme is betaine hydrochloride with pepsin. It should be taken as three capsules while eating, never on an empty stomach. It should not be used by people who have ulcers or gastritis.
More details can be found in my book “Diabetes Solution,” which is available at most bookstores and at www.amazon.com. A chapter is devoted to the treatment of gastroparesis. It also covers the proper use of insulin forpeople with gastroparesis. One of the most important tips is to never use lispro insulin (commonly used in insulin pumps) to cover meals. It works faster than the stomach can empty food.
