What are the causes of common gastrointestinal symptoms of diabetes?

An inattentive & underreported cause of diabetic morbidity affecting the quality of life negatively is gastrointestinal (GI) symptoms along with a poor understanding of the pathophysiological linkage between glycaemic control.

The occurrence of diabetes-associated GI symptoms is dependent on body mass index, gender, psychological comorbidities, helicobacter pylori infection & age. It is higher in women with greater psychological distress, anxiety & depression.

Chronic diabetic gastroparesis leads to complications like ulcer peptic disease, partial gastric or intestinal obstruction, gastric cancer, and pancreatic biliary disorders

Frequent diabetic GI symptoms

Mostly influenced by the nerve damage intensity, glycaemic control, diet & therapy compliance.

1. Bloated abdomen & fullness feeling 
2. Nausea linked to vomiting
3. Weight loss
4. Heartburn
5. Erratic blood glucose levels
6. Stomach wall spasm

Pathophysiology

Key causes are of endocrine, neurological, and metabolic origin.  It is initiated by delayed gastric emptying associated with multiple motor & sensory upper gut function abnormalities.

1. Sometimes may be due to insulin-growth factor reduction resulting in smooth muscle atrophy
2. There can be autonomic & peripheral neuropathy (vagus nerve damage) causing central nervous system changes & gastric inhibitory peptide loss
3. Interstitial cells of Cajal get depleted leading to arrhythmias linked with nausea & vomiting
4. There is pivotal enteric nervous system neuron alteration which creates uneven smooth muscle contraction, emaciation & fibrosis
5. Gastrointestinal peptide production which is responsible for gastric motility changes and giving rise to pyloric spasm
6. Simultaneously there can be an occurrence of myelinated & unmyelinated fibre loss
7. Oddity comprises hypomotility, disturbed ingested food intragastric distribution, inefficient contraction of the intestine, enhanced fundic compliance & uncommon gastric sensation.

Blood glucose level & gut functioning

Insulin delivery which is linked with carbohydrate absorption makes crucial changes in the gastric motility of diabetics. Postprandial antral contraction & gastric motility reduce during hyperglycemia and increase during hypoglycemia. Enhanced blood glucose levels cause disturbances in proximal stomach perception, reversible vagal efferent dysfunction & provide an always stomach fullness feeling.

Remedies

• Appropriate blood glucose level maintenance & good control of metabolic abnormalities like ketosis, uremia & hypokalaemia
• Staying away from medication which slows down gastric emptying
• Making dietary changes to low-residue, less-fat small frequent meals as per dieticians' advice
• Combining pharmacotherapy & get used to alternative feeding methods as per healthcare professional’s recommendations

Conclusion

The usage of validated measures to quantify GI symptoms in diabetics & unwrapping the appropriate pathology in the right way are crucial for both the diagnosis & management of diabetic gastroparesis.

To handle difficult diabetic gastroparesis cases, an experienced healthcare team with a flexible perspective & supreme alertness toward the presence of autonomic issues & complications in patients is mandatory. Cumulatively efforts will improve gastroparesis symptoms throughout therapy.

References

1. Diabetes Care 2018;41:627–637
2. Diabetes Ther (2016) 7:379–386
3. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 2023, VOL. 58, NO. 1, 3–6
4. Rev Colomb Gastroenterol. 2020;35(4):471-484. https://doi.org/10.22516/25007440.561
5. Journal of Diabetes Nursing,2015; 19: 12–18

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