Diabetes is a metabolic disorder that impairs the body's ability to manage sugar intake and levels. Its global prevalence is rising due to lifestyle factors, leading to increased morbidity. Diabetes affects multiple organs of the body, including the digestive system. High blood glucose levels affect the nervous system including the autonomic nervous system (the one responsible for involuntary functions of the body, like digestion, respiration, heartbeat, etc.). This results in gastroparesis, a condition where the stomach isn’t emptied properly because the nerve supply to the stomach is damaged and the muscles become weak. Symptoms may include constipation, bloating after meals, nausea, vomiting, and heartburn. Bloating or discomfort after meals can develop, even after taking a small quantity of food. The appetite is reduced if these symptoms persist. Due to the weakening of the muscles of the digestive system, absorption is also affected. This leads to malnutrition and deficiency of essential nutrients in the individual. Overall, it affects the quality of life of a person. Because a good appetite, proper intake of food and adequate digestion form the very basics of how healthy a person is and how energetic they feel. Absorption of tablets is also affected due to autonomic neuropathy of the alimentary system in diabetes, thus affecting good control of diabetes. Advancing age, prolonged diabetes, and poor diabetes control are risk factors for developing autonomic neuropathy in the digestive system. Hypertension, high lipid levels, smoking, and intake of alcohol, are other risk factors. Genetic factors also influence the development of this condition. Once this problem has developed, it usually progresses, unless detected in early stages and checked by optimal control. Usually, it has advanced to some extent, when symptoms manifest and become persistent. Diagnosis is based on strong clinical suspicion and by different scans. These digestive disturbances can be prevented by good optimal control of diabetes. This can be achieved by maintaining a healthy lifestyle that includes a balanced diet, regular exercise, and the avoidance of alcohol, tobacco, and other addictive substances. One should take the prescribed medicines regularly. It is also important to monitor blood glucose regularly, to check for control. If one has hypertension, that should also be controlled very well by diet restrictions and suitable manifestations. Treatment depends on the severity of symptoms, the presence or absence of complications, and the age of the patient. Once this condition has developed, it is advisable to take frequent small meals, that should be low in fat and fibre. Fat and high fibre in the diet make digestion slow, delay gastric emptying, and augment symptoms. Food should be thoroughly chewed before swallowing. For individuals with severe symptoms, semi-liquid or liquid foods may be more suitable. It is also important to drink plenty of water. One should quit alcohol and or smoking because they aggravate diabetes and its complications and pose other health risks as well. It is also advisable to avoid sodas. Before taking nutritional supplements, the treating doctor should be consulted. It is also very beneficial to do regular physical activity. Taking a short walk after food also helps in improving digestion. Some medications that are used to stop vomiting regulate the motility of the alimentary system, hence aiding in movements of the stomach muscles and pushing food through. They help in relieving symptoms of affection of the gastrointestinal system by diabetes. In severe cases or wherever feasible, some surgical interventions are also carried out. People with diabetes should be aware that uncontrolled diabetes can affect their digestion and so efforts should be made to prevent it. If there is a recent onset of alteration in bowel habits, abdominal bloating after meals, heartburn, nausea, and or vomiting—one or more of these symptoms—seek medical help. Dr Rachna Pande is a specialist in internal medicine. rachna212002@yahoo.co.uk
