Diabetes a Common Cause of Gastroparesis

March 1st, 2011

stomach
Diabetes is the most common cause of gastroparesis, or delayed gastric emptying. That's because high blood sugar causes chemical changes in nerves, including the vagus nerve, which controls the movement of food through the digestive tract. High blood sugar also damages the blood vessels that carry oxygen and nutrients to the nerves, further impairing their functioning.

When the vagus nerve is damaged, then the passage of food through from the stomach through the digestive track slows, or even stops. People commonly suffer from a wide range of gastroparesis symptoms, making the condition difficult to diagnose. Frequency and severity of symptoms also vary widely from individual to individual. Common symptoms are:

? heartburn

? nausea

? upper abdominal pain

? loss of appetite

? bloating

? stomach spasms

? weight loss

? vomiting undigested food

? feeling full after eating small amounts

? gastroesophageal reflux

? high or low blood glucose levels

Food that stays undigested in the stomach can harden into solid masses called bezoars. Bezoars not only cause nausea and vomiting; they can be dangerous if they block the passage of food into the small intestine. Undigested food can also ferment, leading to bacteria overgrowth.

Gastroparesis can complicate diabetes control in both type 1 and type 2 diabetes by delaying food in the stomach from entering the intestine. This irregular passage of food through the digestive system results in erratic and unpredictable blood glucose levels. When the food is finally absorbed, blood sugar levels may rise unexpectedly.

As a result, diabetics with gastroparesis must check their blood glucose frequently. They may need to adjust their insulin therapy, change the type of insulin they take, or take their insulin after meals instead of before to maintain proper insulin levels.

Gastroparesis is usually a chronic condition. While it can't be cured, it can be treated. People with gastroparesis are advised to eat six small meals a day instead of three large meals, and to avoid hard to digest high fiber and high fat foods and carbonated drinks. Severe cases may require a liquid diet, or even a feeding tube.

Patients are often given a dopamine antagonist such as prescription domperidone for gastroparesis. Domperidone (generic Motilium) treats both the condition and gastroparesis symptoms such as nausea, vomiting, bloating and a "full" feeling. Some sufferers will require antibiotics. Other potential treatments still in the early stages include gastric electrical stimulation, the use of botulinum toxin, and experimental medications.

Diabetics - Beware of Bezoars!

March 3rd, 2011

Bezoars were once prized as magical charms with protective properties. Modern day bezoars are now being battled with weapons like meat tenderizer and Coca Cola, especially in diabetic gastroparesis.

A bezoar is a mass of hardened, undigested food or other material trapped in the digestive system, usually the stomach. Bezoars can also form in the large intestine, the trachea, and the esophagus (especially in children).

The word "bezoar" comes from the Persian for "protection from poison". Bezoars from animals were once believed to be antidotes for any type of poison, and were highly prized and sought after in Europe as a type of medical good luck charm for centuries.

People would place bezoars in their drinking glasses as an antidote to any potential poisons, and even set them into jewelry. There was a gold-framed bezoar in the Crown Jewels of Queen Elizabeth I as recently as 1962. Animal bezoars are still in demand from some practitioners of Asian medicine.

Bezoars are often found in people with diabetes mellitus and impaired gastric functioning, both of which can cause underactive digestive systems. Food that sits motionless in the digestive system mixes with mucus and solidifies into a stone-like lump.

Bezoars are classified by their content. Phytobezoars are the most common type, and are formed from undigested plant material. A diospyrobezoar is a common sub-type of phytobezoar formed specifically by the consumption of unripe persimmons.

Pharmacobezoars are masses of undigested drugs, usually found after an overdose of sustained release medications or antacids. Lactobezoars are formed from milk and other dairy products.

Trichobezoars are basically a large hairball, and are usually the result of a psychiatric condition called trichophagia which involves the compulsive pulling out and eating of hair, which humans can not digest. In 2007, Chicago surgeons removed a ten-pound hairball from the stomach of a young woman with the condition.

Doctors usually treat bezoars by attempting to dissolve them with enzymes, with many doctors directing their patients to swallow meat tenderizer. Severe cases may require surgery, laser therapy or shock wave therapy. Since 2002, there have been a number of cases, primarily in diabetes mellitus patients, where doctors successfully used Coca Cola therapy to dissolve diospyrobezoars.

One documented case involved a diabetic gastroparesis patient with three large diospyrobezoars in his stomach. He was instructed to drink two cans of Coke every six hours. Within 24 hours, the bezoars softened and began to dissolve. The doctors then injected cola directly into each bezoar, which caused them to completely dissolve by the next day. Doctors aren't sure why cola helps dissolve bezoars, but assume it's because of its acidity, possibly aided by its carbonation.

The symptoms of a bezoar are similar to those of gastroparesis (delayed gastric emptying), and include nausea, vomiting, abdominal pain, diarrhea, and a feeling of being full after eating a small amount of food. As diabetes and gastroparesis often occur together, any such symptoms should be taken seriously by a diabetic.

Diabetes Medications May Hold the Clue for New Weight Loss Drugs

March 4th, 2011

Barbie doll with tape measure
Researchers at the University of Pennsylvania are "one step closer to developing effective, FDA-approved treatments for obesity", according to Matthew Hayes, PhD, of the University's School of Medicine. The researchers say current type 2 diabetes medications may hold the clue for new anti-obesity drugs.

Hayes and his team are the first to identify the body mechanisms that produce the feeling of being full, or satiety. This mechanism helps explain why type 2 diabetes medications which target a hormone for insulin production called GLP-1 often promote weight loss, presumably by causing diabetes patients to feel fuller and eat less.

Read the whole story here>Science Daily<.

Animus Issues Urgent Recall Notice to Insulin Pump Users

March 12th, 2011

In a rare development that all insulin dependent diabetics should be aware of, Johnson & Johnson has recalled around 384,000 cartridges for its Animus Insulin Pump.

To date, twenty-two injuries have been reported as a result of faulty insulin pump cartridges leaking at the side where the plunger is. The leaks can result in the diabetic using the cartridge receiving a lower insulin dosage than they intended.

Johnson & Johnson has posted an urgent notice on their Animus division website warning consumers to check their cartridge supply and to stop using any of the 2.0 ml cartridges in question immediately. It is also contacting insulin pump users, or as they refer to them, "insulin pumpers", that may have purchased the faulty cartridges, and shipping them replacement cartridges. The website notice reads in part:

Please note that under-delivery of insulin can cause high blood sugar and/or diabetic ketoacidosis. These are serious conditions that can cause severe health impact, including death. Symptoms of diabetic ketoacidosis may include nausea, vomiting, shortness of breath and excess thirst/urination. Contact your healthcare professional immediately if you are experiencing any of these symptoms.

Ketoacidosis usually develops slowly over 24 hours, starting with symptoms such as fatigue, mental stupor, decreased appetite, loss of appetite, headache, and fading consciousness. Other ketoacidosis symptoms all insulin dependent diabetics should be aware of include stomach or abdominal pain, a flushed complexion, and breath that smells like fruit or nail polish remover.

The insulin cartridge recall extends to the US and France. The recall applies only to lot numbers B201575, B201576, B201581, B201582 and B201583. The insulin pump cartridges in questions were shipped between November 30th, 2010 and January 4th, 2011.

Animas has provided the following instructions for insulin pumpers diabetics with a recalled insulin cartridge who need to disconnect their infusion sets:

1) Disconnect the infusion set from your body (failure to follow these important safety instructions can lead to unintended delivery of insulin).

2) Unscrew the cartridge cap, leaving the tubing connected to the cartridge.

3) With the tubing connected to the cartridge, pull the cartridge straight out of your insulin pump.

4) Disconnect tubing from cartridge, set the cartridge aside to return to Animas.

5) Fill a new cartridge from an unaffected lot not listed above, and attach infusion set tubing.

6) While still disconnected, rewind, load the cartridge and prime.

7) Connect tubing to site once prime is complete.

8)Fill cannula only if you have inserted a new infusion set.

Animas Customer Support can also be reached by phone toll-free at 877-937-7867.

Giving Your Cat Insulin Injections

March 14th, 2011

cat in gardenIf you have experience with feline diabetes you know how hard it can be to watch your furry family member suffer through weakness, vet appointments, diet changes and, possibly the most challenging of all, insulin injections. Knowledge of proper cat insulin injection techniques can make your life and your cat's life easier. If you have any questions or concerns talk to your vet.

Prepare the Insulin

  • Start by filling the insulin syringe slightly more than your cat's dose
  • Tap the insulin syringe to remove air bubbles
  • Slowly push the plunger until you have the correct dosage of insulin in the syringe

Prepare Your Cat

Create a routine to make your cat comfortable. At first he will likely try to get away, but eventually he should become familiar with the process, and you may even be able to train him to come when it is time for his insulin injection. Start by giving him lots of attention and affection, and maybe even a small treat. It is probably best to keep the insulin syringe out of your hands at first, so that he does not get scared. When you are ready to give your cat insulin, get on his level - don't come at him from above or he will feel threatened. Now it is time to find the injection site.

Injection sites

The scruff (top of the neck) is the most commonly used injection site for insulin for cats, however it may not be the best. The amount of skin and muscle in this area can slow absorption of the insulin, and can be more painful for the cat.

Other options for injection are the flank (between the ribs and the legs), the side or underside of the belly, and the side of the chest. Absorption tends to be quickest when given in the side or underside of the belly.

Insulin Injection

Each cat is different, and the proper type, dose and frequency of insulin for cats need to be determined by a veterinarian. Once you know the proper insulin dosing and have determined the best place for injection, place your thumb and index finger approximately an inch apart and pinch the skin to create a "tent". Make sure you are not grabbing any muscle.

The insulin injection should go into the hollow space under the "tent" of skin. It should not go into the skin itself, or into the muscle. If your cat is long-haired make sure that you can see the skin and that you are not giving him a "fur shot".

When you are giving the insulin injection be confident, smooth and fast. It is the puncture part that hurts, so go quickly through that part; you can slow down a bit while you inject the fluid.

Above all, be gentle and kind when giving your cat insulin, especially at first, and praise him when it is all done.

Adjusting to Life With Childhood Diabetes

March 14th, 2011

It's hard enough to cope with parenting an adolescent, and if you throw juvenile diabetes into the mix it may feel impossible. Educate yourself, make a plan with your diabetes team, and keep lines of communication open between you and your child, and you can go back to disagreeing about things like dating and borrowing the car.

Signs and Symptoms

Because of the changes your child will experience with puberty, the signs and symptoms may be difficult to recognize, so regular check-ups are important. Type 1 diabetes usually shows up at 10 to 12 years of age in girls and around 12 to 14 years of age in boys, but may present earlier or later. Some of the symptoms of diabetes in children are:

  • Fatigue
  • Extreme weight loss
  • Increased appetite
  • Increased thirst and frequent urination
  • Irritability

If you notice these signs in your child, it is important to talk to your doctor so that she can run tests. If the tests confirm that your child has diabetes, he may need to go straight to the hospital to get help stabilizing his blood sugar levels. Your doctor and other health care professionals will work with you to make a plan to maintain those healthy blood sugar levels. This may include diabetes medication, insulin injections and diet and exercise changes.

Making Changes

As you make the necessary lifestyle changes continue to talk to your child so that he is aware of what he needs to do, and more importantly, why he needs to do it. Giving him the tools and information he needs to fully understand the situation will help him to make healthy decisions down the road.

Ease into the changes so that the transition is not too jolting. If your child is inactive, start with small amounts of activity as a family every day. Buy whole grain products instead of white flour, and try to incorporate vegetables or fruit at all meals.

Attitude

Stay calm when discussing your child's diabetes with him. Instead of focusing on what he won't be able to do, or all the things that will change, focus on all the things that he will continue to be able to do. He will still be able to have fun with his friends, play sports and go to school. Get him involved in meal planning and, when you and your child feel he is ready, let him do his own insulin injections. If he feels he still has independence it will make the adjustments easier on everyone.

Diabetize Your Favorite Recipes

March 23rd, 2011

Part of the challenge of living with diabetes is eating well without feeling deprived. The American Diabetes Association has some helpful tips to "diabetize" your favorite family recipes so they can remain part of your lifestyle. Among their suggestions:

1) Reduce sodium.

2) Reduce saturated fat.

3) Pump up the vegetables.

4) Increase fiber.

5) Reduce portion size

Click here for the full post >American Diabetes Association.<

Artificial Pancreas Awaiting FDA Approval for Clinical Testing

March 26th, 2011

The artificial pancreas is a unique combination of three main closed-loop components:

1) A continuous glucose monitor for ongoing blood sugar levels and patterns

2) A programmable computerized insulin pump

3) An advanced computer algorithm (formula) that can calculate how much insulin the body needs, and when it needs it

Although just the "research and development first step" towards a fully functioning artificial pancreas, the insulin delivery system now awaiting approval for clinical trials is, according to Animas' Chief Medical Officer and director of Project Manya, Dr. Henry Anhalt, "leaps and bounds above technology that is currently available."

Anholt points out that current insulin pumps, which he calls "unintelligent", can monitor blood glucose and dispense insulin, but still require users to input and interpret a lot of data. While some decisions will still have to be made by users until the device is fully automated, Anholt says the new artificial pancreas can "assist the patient and in many ways, take over the decision-making process".

Once perfected, the new technology will have a monumental impact on the quality of life of insulin dependent diabetics. Not only will the new insulin delivery system simplify the constant challenge of controlling blood sugar, accurate insulin dosing and administering insulin injections, the resulting tight blood sugar control will help ward off a host of diabetes complications such as blindness, nerve damage, amputations and kidney and heart disease.

New Hormone Pathway May Replace Insulin Therapy for Diabetes

March 28th, 2011

Researchers have discovered a hormone pathway that they are hopeful may eventually lead to new type 1 diabetes treatments to replace insulin therapy. Currently, America's approximately one million type 1 diabetics rely on multiple insulin injections per day to control their blood sugar.

The pathway involves a hormone with insulin-like characteristics called fibroblast growth factor 19 (FGF 19). Unlike insulin, FGF 19 does not cause excess glucose to be stored as fat, also raising the prospect of a new anti-obesity treatment.

To read the whole story, click here >Science Daily<.

Diabetes in Children: Adjusting to Life with Juvenile Diabetes

March 29th, 2011

It's hard enough to cope with parenting an adolescent, and if you throw juvenile diabetes into the mix it may feel impossible. Educate yourself; make a plan with your diabetes team, and keep the lines of communication open between you and your child, and you can go back to disagreeing about things like dating and borrowing the car.

Signs and Symptoms

Because of the changes your child will experience with puberty, the signs and symptoms of diabetes in children may be difficult to recognize, so regular check-ups are important. Type 1 diabetes usually shows up at 10 to 12 years of age in girls and around 12 to 14 years of age in boys, but may present earlier or later. Some of the symptoms of juvenile diabetes are:

  • Fatigue
  • Extreme weight loss
  • Increased appetite
  • Increased thirst and frequent urination
  • Irritability

If you notice these signs in your child, it is important to talk to your doctor so that she can run tests. If the tests confirm childhood diabetes, he may need to go straight to the hospital to get help stabilizing his blood sugar levels. Your doctor and other health care professionals will work with you to make a plan to maintain those healthy blood sugar levels. This may include diabetes medication, insulin injections and diet and exercise changes.

Making Changes

As you make the necessary lifestyle changes, continue to talk to your child so that he is aware of what he needs to do, and more importantly, why he needs to do it. Giving him the tools and information he needs to fully understand childhood diabetes will help him to make healthy decisions down the road.

Ease into the changes so that the transition is not too jolting. If your child is inactive, start with small amounts of activity as a family every day. Buy whole grain products instead of those made from white flour, avoid sugary foods, and try to incorporate vegetables or fruit at all meals.

Attitude

Stay calm when discussing juvenile diabetes with your child. Instead of focusing on what he won't be able to do, or all the things that will change, focus on all the things that he will continue to be able to do. He will still be able to have fun with his friends, play sports and go to school. Get him involved in meal planning and, when you and your child feel he is ready, let him do his own insulin injection. Many children find the newer insulin pens

easier to use than the traditional insulin syringes. If he feels he still has independence it will make the adjustments easier on everyone.

Click >here< for some advice from teen superstar Nick Jonas, who was diagnosed with juvenile diabetes at age 13.

International Diabetes Association Supports Bariatric Surgery as Treatment Option in Diabetes Control

March 31st, 2011

surgery

The International Diabetes Association (IDA) has taken the position that bariatric (weight loss) surgery should be considered early on as a cost-effective treatment option to avoid serious complications in type 2 diabetics who are moderately or severely obese.

The IDA 2011 position statement was released around the same time that the FDA expanded the approval of the Lap-Band Adjustable Gastric Banding System procedure for use in a wider range of obese patients, including diabetics.

The Lap-Band procedure was first approved by the FDA in 2001 for patients with a body mass index (BMI) of 40 or higher, or for those with a BMI of 35 and at least one other serious obesity-related condition, such as diabetes mellitus or high blood pressure.

Lap-Band gastric banding is now approved for those with a BMI of 30 to 35. But bariatric surgery of any kind should only be used when conventional methods weight loss methods such as diet and exercise have failed. Any such surgery must be accompanied by long-term lifestyle changes such as diet and exercise to be successful.

Both gastric banding and sleeve gastrectomy are minimally invasive laparoscopic surgeries, performed through small incisions in the abdomen. In gastric banding surgery, an inflatable silicone device is place on the top portion of the stomach to create a small pouch.

This pouch will only hold about cup of food, as opposed to the 6 cups a normal stomach will hold. The smaller stomach not only helps the patient eat less by making them feel full sooner, it also slows the passage of food into the rest of the stomach and the digestive tract. As the patient loses (or gains) weight, the band is adjusted to maintain comfort and effectiveness.

In a sleeve gastrectomy, the stomach is surgically reduced to about one-quarter of its normal size, leaving it the shape of a narrow "sleeve" or tube. The portion of the stomach that is removed secretes an appetite hormone called Ghrelin. Once removed, the patient's appetite is said to decrease. The procedure is irreversible.

A gastric bypass is a more complicated irreversible gastrointestinal surgery in which a pouch is created at the top of the stomach, and then connected directly to the middle of the small intestine, bypassing the rest of the stomach and the upper intestine, or duodenum. The part of the intestines that is bypassed is where vitamins and minerals are the most easily absorbed, meaning patients must guard against nutritional deficiencies following a gastric bypass.

Studies published in the Archives of Surgery comparing the newer laparoscopic gastric banding surgery and sleeve gastrectomy to the conventional gastric bypass surgery found that, while conventional bypass surgery resulted in higher weight loss, the less invasive Lap-Band procedure was "safer", with fewer complications.

Many bariatric surgery experts believe that surgery which bypasses the duodenum is the most effective for diabetes control because the duodenum plays a role in insulin resistance, and bypassing it reduces insulin resistance in patients with diabetes mellitus. A gastric bypass also results in the most weight loss. "It's very clear - bypass is better than band, period," states bariatric surgeon Dr. Guilherme M. Campos from the University of the Wisconsin School of Medicine, "And if you are diabetic with obesity, the best treatment is a Roux-en-Y gastric bypass."

Dark Cocoa May Lower Insulin Resistance

March 31st, 2011

dark cocoa

Dark cocoa has been linked to a reduction in risk factors for diabetes such as high blood pressure and high cholesterol. Dark cocoa has also been shown to lower insulin resistance in diabetics.

It's believed that the health benefits arise from the polyphenolic flavonoids in cocoa - antioxidants with the potential to prevent heart attacks which are also found in fruits, vegetables, tea, coffee and wine.

Most commercial chocolate is high in sugar and fat, offsetting its possible health benefits, so more research is needed about the risk/benefits ratio of eating a regular dark chocolate bar.

To read the entire article on WebMD, click >HERE<.