Diabetic Gastroparesis: An Overview

Written by Frances Gatta
Medically Reviewed by Shruthi N, MD on January 17, 2025
6 min read

Diabetic gastroparesis is a diabetes complication in which the stomach muscles stop working well or at all, slowing down how quickly food leaves your stomach to your intestine. It can make you feel queasy and vomit and is bad for your blood sugar levels.

Although diabetic gastroparesis is more common in people with type 1 diabetes, people with type 2 can also get it.

Most people with gastroparesis have had diabetes  for at least 10 years and also have other complications related to the disease.

 

 

Diabetic gastroparesis results from a variety of factors, including high blood sugar levels and problems with the vagus nerve. The vagus nerve controls how quickly your stomach empties. When it's damaged, digestion slows down, and food stays in your body longer than it should.

Over time, diabetes can affect other parts of your body. It can cause problems with your stomach’s smooth muscle and pacemaker cells, which help move food in and out of the stomach.

If you have diabetic gastroparesis, your symptoms may include:

Food that stays in your stomach too long can spoil and lead to the growth of bacteria. Undigested food can harden and form a lump called a bezoar. It can block your stomach and keep what you eat from moving into the small intestine.

Gastroparesis can make it hard to control diabetes. When food finally does leave your stomach and enters the small intestine, your blood sugar goes up, too.

Also, the vomiting that can come with diabetic gastroparesis can leave you dehydrated.

Your doctor will ask about your symptoms. They’ll also do a physical exam, and they may check your blood sugar. They might also suggest other tests.

Scintigraphy. With this test, you'll eat food that has a radioactive substance in it. Then you lie under a scanner that detects the radiation. The test takes up to four hours, with a scan taken every hour after your meal. If the scan shows a delay in your stomach emptying,  that more than half of the meal is still in your stomach after 1.5 hours, you have gastroparesis.

Barium X-ray. You drink a liquid (barium), which coats your esophagus, stomach, and small intestine and shows up on X-rays. This test is also known as an upper GI (gastrointestinal) series or a barium swallow.

Barium beefsteak meal. You eat a meal with barium in it, and the doctor uses an X-ray to watch how long it takes you to digest the food. That tells your doctor how quickly your stomach empties.

 

Gastric manometry. Your doctor guides a thin tube through your mouth and into your stomach. It measures muscular and electrical activity in your stomach.

Wireless motility capsule. You swallow this tiny device with a meal. It measures the pressure, temperature, and pH of different parts of your gut.

Electrogastrography. You wear electrodes on your skin to measure electrical activity in your stomach.

Ultrasound. This test uses sound waves to show the inside of your body. An ultrasound will confirm whether your symptoms are coming from issues with your kidneys or gallbladder.

Upper endoscopy. Your doctor will pass a thin tube (called an endoscope) down your throat to view the lining of your stomach and to rule out blockage of your intestines.

 

Although there is no cure, you can manage gastroparesis and its symptoms.

Controlling your blood sugar helps. Ask your doctor if you should change when and how often you use insulin, and check your sugar levels more often. There are many treatment options for diabetic gastroparesis.

 

Medications

For some people with gastroparesis, medications can help. Metoclopramide (Reglan) is the only FDA-approved medication for gastroparesis. It makes your stomach muscles move, which helps food leave your stomach. It may also prevent nausea and vomiting. Other medications that can ease gastroparesis symptoms include:

  • Dimenhydrinate (Dramamine) and diphenhydramine (Benadryl) are over-the-counter antihistamine s that can help prevent nausea and vomiting.
  • Domperidone (Motilium) manages problems in your upper digestive system that are linked to gastroparesis.
  • Erythromycin, an antibiotic, also helps your stomach to move food out.
  • Ondansetron (Zofran) blocks chemicals in your brain and stomach that cause nausea and vomiting.
  • Prochlorperazine (Compazine) helps control nausea and vomiting.

Talk with your doctor about whether you should stop or change medications that might worsen gastroparesis. These include antidepressants, high blood pressure drugs, and certain diabetes treatments.

Procedures

With a procedure called gastric electrical stimulation, a surgically implanted device sends brief, low-energy impulses to your stomach to help with nausea and vomiting.

In extreme cases, you may need a feeding tube (also called a jejunostomy tube). A surgeon will put a special tube through your abdominal wall directly into your small intestine. You "eat" specially made liquid meals through the tube instead of food going through your stomach.

When you have diabetes, one of the best ways to help control the symptoms of gastroparesis is to vary when and how you eat. Instead of three times a day, you can have six small meals. You'll have less food in your stomach, so you won't feel as full. It'll be easier for the food to leave your stomach, too.

Also, pay attention to the texture of food. Liquids and things that are easy to digest are a good idea. For example, choose applesauce instead of whole apples. You can also try soups or pureeing your food.

Avoid foods that are high in fat, which can slow down digestion. Watch out for fiber, which takes longer for your body to process.

Gastroparesis diet

Working with a dietitian to manage your diet can also help. They may recommend a plan that involves reducing how much fat you take to 25% to 30% of total calories and reducing your fiber intake to 15 grams for every 1,000 calories you have. 

Some other tips include:

  • Try mild exercise after a meal
  • Avoid carbonated drinks and alcohol
  • Eat and drink at different times, not together
  • Eat well-cooked fruits and vegetables
  • Don't smoke

 

Diabetes gastroparesis is a complication of having uncontrolled or poorly controlled type 1 or type 2 diabetes. It happens when high blood sugar levels start affecting your stomach muscles and cells, causing problems with how food leaves your stomach. When you have it, you’ll most likely have nausea. See a doctor if you have these symptoms and others like unexplained weight loss or weight gain, vomiting, and loss of appetite. It has no cure, but treating high blood sugar levels, diligently taking other medicines your doctor recommends, and changing your diet and eating habits can help. 

How can stress impact diabetic gastroparesis?

Oxidative stress is when your body has too many free radicals (unstable molecules) and not enough antioxidants to remove them. It can also contribute to you having diabetic gastroparesis by causing your body to lose functions that help your stomach muscles contract and relax.

Are there any new and experimental treatments for diabetic gastroparesis?

Relamorelin is a new medicine under development for diabetic gastroparesis. It could help your stomach move food out more quickly and reduce vomiting. Another procedure called endoscopic pyloromyotomy is an experimental treatment for diabetic gastroparesis. It involves making a cut between your stomach and intestine so that food can leave your stomach. It is also still being studied. 

What lifestyle changes can prevent gastroparesis?

Reducing your intake of fatty and high-fiber foods, eating easy-to-digest foods, and having smaller meals more often can help prevent gastroparesis symptoms.

How can you surgically treat diabetic gastroparesis?

You can surgically treat diabetic gastroparesis with a procedure called gastric electrical stimulation, which involves implanting a device that controls your stomach muscles to help it move food. 

How does gastric pacing impact gastroparesis? 

Gastric pacing is the same as gastric electrical stimulation. It helps with gastroparesis because the implanted device sends brief, low-energy impulses to your stomach, which helps move food out. It also helps with symptoms like nausea and vomiting.