Stomach Pain and Type 1 Diabetes

Introduction

Regarding type 1 diabetes (T1D), pain in and near the stomach means different things. When type 1 diabetes gets diagnosed, this is one of the common symptoms that occur. In this autoimmune condition, this symptom develops fast and becomes life-threatening if it is not diagnosed in an early stage. Stomach pain can already exist in type 1 diabetes, and some people experience high glucose levels, which can eventually lead to a serious condition called diabetic ketoacidosis. Another condition called gastroparesis can also happen with diabetes, which causes bloating or stomach pain after having a meal.

What Are the Symptoms Seen in Type 1 Diabetes?

In the United States, around 1.6 million people have type 1 diabetes. This autoimmune condition happens when the body's immune system attacks itself, making the pancreas stops producing insulin hormones. The signs of T1D include the following:

• Nausea and vomiting.

• Abdominal pain.

• Frequent urge to urinate.

• Increased thirst and hunger.

• Unexplained weight loss.

• Increased fatigue.

• Blurry vision.

• Cuts and bruises that take a long time to heal.

• Vaginal yeast infections.

An undiagnosed type 1 diabetes can become life-threatening and rise to a medical emergency.

What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a complication occurring from type 1 diabetes. When the body does not have enough insulin to convert glucose into energy, it starts breaking down the fat. The body releases ketones to the bloodstream following this, making the blood more acidic. DKA has a severe and sudden onset, which has to be treated immediately with insulin. Symptoms seen in DKA include:

• Nausea and vomiting.

• Abdominal pain.

• Breath smelling like fruit.

• Drowsiness or sleepiness.

• Increased breathing.

• Loss of consciousness and confusion.

DKA is a medical emergency; if left untreated, it can cause coma and death. It can happen when the insulin pump break or stops delivering the insulin required to the body. In some cases, undiagnosed people can experience DKA without even realizing what's going on. It can also occur in people diagnosed with the condition if they are not getting sufficient amounts of insulin.

What Is Gastroparesis?

Gastroparesis is a frequent issue that type 1 diabetes people experience. Research suggests that 40 percent of people with type 1 and 30 percent with type 2 diabetes experience this condition. Gastroparesis, also called chronic delayed gastric emptying, is a digestive disorder where the muscles of the stomach malfunction and slow down the rate of food movement from the stomach to the intestines. Gastroparesis causes symptoms like nausea, vomiting, bloating, feeling overly full after eating and feeling full much sooner. Depending on the severity of gastroparesis, it significantly impacts a person's life quality.

How Is Gastroparesis Diagnosed?

• The healthcare practitioner will perform a physical examination and take a detailed medical history to diagnose gastroparesis.

• The doctor might also run certain tests like an ultrasound or upper endoscopy. These tests will rule out any underlying health conditions impacting the stomach.

• Once a doctor rules out other possible causes, they will order a gastric emptying scan or other tests to evaluate the stomach's emptying. In the gastric emptying scan, the person will be advised to eat food containing a harmless radioactive substance. With this, the doctor can evaluate how the food is digested and emptied from the stomach.

How to Treat Gastroparesis?

Once gastroparesis is diagnosed, it has to be efficiently managed. If left untreated, it can cause frequent vomiting, leading to dehydration which interferes with nutrient absorption leading to malnutrition in the long term.

Dietary Modifications:

1. The doctor will recommend certain dietary modifications. This involves eating small rather than large meals and soft foods that can be digested easily.

2. Eating fatty foods will slow the stomach-emptying process and worsen the condition. It is recommended to reduce the fat intake or not to exceed about 25 to 30 percent in the daily intake of calories.

3. It is advised not to eat more than 15 grams of fiber per thousand calories.

4. Drink enough amount of water. The Center for Disease Control and Prevention (CDC) recommends about six to ten cups of water daily for adults.

5. Always keep in mind that dietary modification alone cannot treat gastroparesis.

Medical Interventions:

1. Medications will be recommended to reduce nausea and improve gastric emptying.

2. Antiemetics will be given to reduce vomiting and nausea.

3. Metoclopramide is the most commonly used drug for gastroparesis. This medicine stimulates stomach movement and eases symptoms like nausea and vomiting. This drug belongs to the prokinetics category, several of which have been successfully used to treat gastroparesis.

4. The doctor will also review medications to understand whether they are the causative factor.

5. Some drugs that slow the process include antihistamines, benzodiazepines, calcium channel blockers, proton pump inhibitors, opioid painkillers, tricyclic antidepressants, and H2 receptor agonists.

6. Other treatment modalities may be tried when people do not respond well to medications. These include procedures like gastric neuromodulation or gastric electrical stimulation. Both these procedures stimulate the gastrointestinal system and improve their symptoms.

7. Enteral or liquid nutrition is given to people with severe cases. This means feeding through a tube inserted into the stomach or this small intestine. The surgeon will perform a gastrostomy, creating an opening to place a feeding tube.

What Are the Other Considerations for Type 1 Diabetes-Related Stomach Pain?

• If a person is struggling with gastroparesis, a review of the diabetes management strategy will be suggested by the doctor.

• If the stomach emptying happens slowly and a longer time is required to absorb the nutrients, then it is necessary to adjust the timing of insulin before a meal. For example, if a person is taking insulin 15 to 20 minutes before a meal, it is called pre-blousing. This method will allow the insulin to enter a person's bloodstream before the food enters the body, and it starts raising the glucose levels.

• Using a continuous glucose monitor and an insulin pump to control blood glucose levels is also recommended.

Conclusion

Stomach pain can be a symptom of the increased blood sugar level, a sign of undiagnosed type 1 diabetes, or even a life-threatening diabetic ketoacidosis emergency. For people who have been diagnosed with type 1 diabetes, stomach pain can be a sign of certain aspects of diabetes that needs an appropriate review by the healthcare practitioner. Gastroparesis can also occur in people with diabetes, which causes stomach problems. This condition is incurable. However, it can be managed by changing eating or drinking habits and other medical interventions like medications or procedures. It is always necessary to speak with the respective diabetes care team or doctor to determine the best solution for the underlying stomach issue.