Diabetes can induce inflammation causing apoptosis, effecting major changes along the entire length of the GI tract down into the colon. Diabetic gastroparesis is the real culprit to the problem that we’re facing with GI pain in these patients. And so our goal is to try to help that symptom by controlling diabetic gastroparesis by a variety of methods. Lifestyle modifications for GI patients include things like chewing their food well and eating smaller portions. We suggest lower fat content meals because fat can delay gastric emptying and that’s already a problem in and of itself for these patients. We also promote some more liquid meals, like soups and stews. It’s actually an interesting phenomenon: these patients have a protective effect in that their liquid passing rate is preserved.
Biofeedback and cognitive behavioral therapy and imagery techniques can help control their abdominal pain and the stress which we know can further exacerbate pain. Then we may progress to pharmacological agents, primarily prokinetic agents, and antiemetic agents. We try to use things like tricyclic antidepressants or anticonvulsants to try to spare some of that opioid effect, which we see as a possible propagating effect with opioids and the problems that these patients have. Further along, in refractory cases, we may think about patients who might be a good candidate for a gastric stimulation.