Top Document: diabetes FAQ: treatment (part 3 of 5) Previous Document: Has anybody heard of frozen shoulder (adhesive capsulitis)? Next Document: Extreme insulin resistance See reader questions & answers on this topic! - Help others by sharing your knowledge J K Drummond (no longer on the net, but well) contributed this section. Gastroparesis (gastroparesis diabeticorum if a diabetes complication) is nerve damage caused delayed gastric emptying. This more common than recognized irregular digestive slowdown interferes with blood glucose regulation and oral medicine absorption. Severity ranges from occasionally recurring bothersome symptoms like nausea, vomiting, constipation and diarrhea to total "stomach paralysis" -- the inability to consume/absorb any food. This worst stage requires tube feedings as the sole source of nutrition, IVs for hydration, and gastric suction for waste elimination. Be aware that "stomach trouble" may be more serious for one with diabetes and report digestive problems to your physician. Do not wait until you have had gastroparesis for several years or end up in the emergency room because you cannot eat. If you are a health professional, please routinely ask diabetics if they have digestive problems. Many with gastroparesis are undiagnosed or misdiagnosed and find little information about it. Often they have been used as guinea pigs in guessing games of hit or miss treatment trials. The scary quest has only just begun to find answers, reason, and solutions to this lesser known and mystifying complication of diabetes. There are people who have found answers in their lonely struggle with gastroparesis. Most folks with gastroparesis are female, with type 1 diabetes for 20-25 years and are age 25-45 at onset of gastroparesis. These incomplete lists of symptoms, treatments, helpful & stressful foods, and social aspects have been compiled mostly from patient reports. There is no all-patient guarantee of experience. CHECK WITH YOUR DOCTOR! S Y M P T O M S Physical Psychological nausea fatigue- muscle weakness vomiting fear constipation frustration diarrhea stress bloating lack of hunger indigestion high stomach acidity reflux weight loss inability to control blood sugars DIAGNOSIS** Symptoms together with gender &/or years of diabetes (clinical intuition) Gastric Mobility Transit Test Manometric Motility Study Diabetics are also subject to all forms of non-diabetic gastropathy so be aware that tests are necessary to eliminate and/or verify other diagnoses. TREATMENTS NUTRITION - MALNUTRITION Dietitians recommend 6 small meals daily Foods more easily digested Foods increasing symptoms fruit juices protein foods - meat, eggs canned fruits & vegetables raw fruits & vegetables soft starches (white bread dairy products & rice, mashed potatoes, cereals) caffeine, chocolate soups nuts & seeds baby foods non-carbonated beverages jello Liquid Nutritional Supplement Drinks Diabetic: Choice dm (Mead-Johnson), Glucerna (Ross Labs) Ensure Glucerna OS (Ross Labs) Non-diabetic: Ensure/Ensure plus, Sustacal (Ross Products Div) Nutrition via: IVs (fluids or TPN) Tube feedings (eq. Osmolite or Supplena) PHYSICAL - Remaining upright at least a half hour after eating, stomach massage, enemas, glycerine suppositories, stool softeners (for example, psyllium husk powder: Metamucil and other brands) DRUGS - May have adverse side effects on other conditions. Ask your MD! Reduce stomach acid: Zantac, Pepcid, Prilosec, Axid, Cytotec Increase motility: Reglan (metoclopramide) erythromycin Propulsid (cisapride) (in U.S. only under compassionate use protocol) bethanechol domperidone (U.S. availability: compassionate use only, and for veterinary use -- it's used to treat fescue toxicosis in horses) Zelnorm (tegaserod maleate), labeled in the US as of 2002 to treat women with irritable bowel syndrome (IBS) dominated by constipation. Zelnorm increases serotonin activity in the bowel by activating some 5HT4 receptors, which increases serotonin in the bowel and increases motility. The percentage of IBS patients who benefit is small but significant. It's not clear why the labeling is limited to women, though it seems likely to be a combination of the fact that 2/3 of IBS patients are women and the clinical studies barely reached statistical significance. If the effects in gastroparesis follow those in IBS, a small percentage of patients will see improvement, and some of those will be helped a lot. Information from the Zelnorm prescribing information on the http://www.zelnorm.com web site. Reduce digestive system spasm: dicyclomine Diarrhea: immodium, clonidine Nausea/vomiting: marinol, thorazine, ativan, inapsine, zephran, phenergan Surgical (physical implants or alterations) portacath or Hickman - IV hydration or Total Peritoneal Nutrition jejunostomy - tube feedings gastrostomy - for stomach suction (PEG tube) gastric resectioning or stomach removal gastric pacing - digestive pacemakers (experimental). Enterra Therapy by Medtronic, gastric electrical stimulation (GES) neurostimulator implants are approved as a humanitarian use device (HUD) since severe gastroparesis (refractory to drugs) has less then 4,000 cases per year. More info at http://www.medtronic.com/neuro/enterra/patient.html insulin pumps SOCIAL & PSYCHOLOGICAL ASPECTS Frustration for patient and physician from the difficulty in balancing insulin dosages and food intake to achieve level blood sugars with unpredictable slowed digestion. Additional psychological impact from delayed treatment due to relative medical unrecognition causing underdiagnosis and even misdiagnosis (ex. as anorexia nervosa if accompanied by vomiting). Lack of ostomy education. If/when eating ability returns following thinking that a normal diet could never again be eaten it may cause physical & emotional anorexia. Often felt burden to friends and family. Most information was collected by the pioneering health professionals of the defunct Gastroparesis Communication Network, updated by J K Drummond. There's an excellent web page on gastroparesis at http://www.uoflhealthcare.org/tabid/473/Default.aspx ** If you have been or are out of work pursue Medicare/Medicaid & Social Security Options IMMEDIATELY! User Contributions:Comment about this article, ask questions, or add new information about this topic:Top Document: diabetes FAQ: treatment (part 3 of 5) Previous Document: Has anybody heard of frozen shoulder (adhesive capsulitis)? Next Document: Extreme insulin resistance Part1 - Part2 - Part3 - Part4 - Part5 - Single Page [ Usenet FAQs | Web FAQs | Documents | RFC Index ] Send corrections/additions to the FAQ Maintainer: edward@paleo.org
Last Update March 27 2014 @ 02:11 PM
|
between and mg/dl and mmol/l is, i came across your article and was so pleased to aquire a lot more info regarding blood glucose, how to read and convert it.