Stomach Pain in Diabetics: Causes and Treatments

Many stomach aches result from temporary gastrointestinal issues which are soon resolved. However, stomach pain may be a sign of a more serious problem such as diabetic gastroparesis which is a result of delayed bowel movement. This inability of the stomach to empty normally leads to a stomach ache referred to as diabetes stomach pain. The condition usually occurs in individuals with diabetes type 1 although it can also affect those with type 2 diabetes. But what are the characteristics of gastroparesis and how is it treated?

What Causes Diabetic Gastroparesis?

Gastroparesis arises when delay occurs in emptying stomach contents. This leads to retention of stomach contents for longer than normal causing bloating, nausea, vomiting, abdominal pain and stomach distention. Most people who suffer from this condition may not tolerate high fiber or high fat foods which may increase acid reflux and heartburn.

Diagnosing Gastroparesis

While medics may base their diagnosis of gastroparesis on the symptoms, it is important that tests be conducted for confirmation of the diagnosis. An endoscopy of the upper GI tract will rule out obstruction. However, the endoscopy is not an accurate way to determine whether gastric emptying takes place normally or not. To make this determination, a barium study of the upper gastrointestinal tract should be done.

How to Deal with Diabetes Stomach Pain

Medical Treatment

While stomach pain has no cure, symptoms can be managed in a number of ways:

Consult with your doctor on the timings of insulin use and monitor your sugar levels more regularly.

Also, ask your doctor whether it is advisable to make changes to your medications to manage the condition. Some medications for depression, high blood pressure and diabetes may worsen gastroparensis.

Medications that may help in the management of gastroparesis include:

  • Dramamine (dimenhydrinate) which is an OTC antihistamine which prevents nausea and vomiting
  • Motilium (domperidone) which treats upper digestive system issues linked to diabetes stomach pain
  • Erythromycin which is an antibiotic that can also aid in bowel movement
  • Raglan (metoclopramide) which causes movement of stomach muscles and thereby improves movement of food through the GI system. Raglan also prevents nausea and vomiting.
  • Zofran (ondansetron) works by blocking some chemicals in the brain and stomach which are responsible for causing nausea and vomiting.
  • Compazine (prochlorperazine) which controls nausea and vomiting

Gastroparensis can also be managed through gastric electrical stimulation procedure which involves surgical implantation of a device that sends out low-energy electrical impulses to the stomach to prevent nausea and vomiting.

In cases of extreme gastroparensis, a feeding tube may need to be inserted into your small intestines, through your abdominal wall. In this case, you will feed on liquid meals which go directly into the small intestines, bypassing the stomach.

Diet Changes

If you are a diabetic, diet change can help in the management of diabetes stomach pain. One way is to change the timing and the type of food that you eat. Try eating five or six small meals instead of three large meals per day. This way, your stomach will hold less food at any one time so you won't feel too full. Besides, it will be easier for the food to pass through your GI system.

Consider the texture of the food you eat too. Go for foods and liquids that are easy to digest. For instance, instead of whole apples, take applesauce.

Also avoid high fat foods because they slow down digestion. The same goes for high fiber foods because fiber takes longer to process.

Other Common GI Conditions in Those with Diabetes

Candida Infections

When you have diabetes, you are more likely to develop a yeast infection within the GI tract. This is more common in cases of poor blood sugar level control. Fungal infections include thrush which affects the mouth, tongue and throat and presents with whitish coating, a burning feeling and pain. If the yeast infection spreads further, it may lead to candida of the esophagus which can present with difficulty in swallowing, heartburn and intestinal bleeding.

Thrush diagnosis can be done by examination, but diagnosis of esophageal candida may require an endoscopy. Both can effectively be treated using oral antifungal medications.

Ulcer Disease

Acid-irritation of the stomach and the esophagus lead to heartburn, poor digestion, and a burning feeling. Gastric and duodenal ulcers are caused by bacteria called helicobacter pylori (H. pylori). Ulcers are treated with medication that suppresses the gastric acid secretion. In case the ulcer is caused by H. pylori, antibiotics are also prescribed. More serious gastro-esophageal issues require proton pump inhibitor procedure because once H. pylori bacteria are eradicated, the symptoms usually worsen.

Enteric Neuropathy in the Small Intestine

Long-term complications of diabetes may lead to damage of the enteric nerve that serves the small intestines. The damage can cause abnormal secretions, absorption and movement of the small intestines. This may lead to diarrhea or bloating. The abnormal retention of intestinal contents may also lead to overgrowth of bacteria in the gut. Treatment may include broad spectrum antibiotics to stem the bacterial overgrowth.

Enteric neuropathy may also cause chronic diabetes stomach pain similar to pain due to peripheral neuropathy in the feet which is a long-term complication of diabetes. Chronic enteric neuropathy is treated using antidepressants and pain medications.

Celiac and Diabetes Connection

Diabetics are also likely to develop celiac disease, which arises due to gluten intolerance. In celiac disease, consumption of foods containing gluten like wheat sets off the immune system to attack and damage the small intestines. The damage affects the villi which are responsible for the absorption of nutrients within the small intestines, rendering them ineffective.

Diagnosis of celiac disease is carried out through endoscopic biopsy of the small intestines and/or a lab test known as anti-gliadin and anti-endomysial antibodies test. There is no known treatment of celiac disease. However, it can be managed by strict adherence to a gluten-free diet. Celiac disease is also known as gluten sensitive enteropathy or coeliac disease.

Fatty Infiltration or Liver Disease

People with type 2 diabetes are prone to getting fatty infiltration or liver disease as a result of poor control of blood sugar. The condition may lead to increased secretion of liver enzymes. It may also cause abdominal pain and may progress to fibrosis or even cirrhosis.

Stomach pain caused by fatty infiltration is diagnosed by examination although an abdominal ultrasonography or percutaneous liver biopsy may be required to confirm it. Treatment involves improving blood sugar control and incorporating a low-calorie diet.