Dr. Einhorn explains what gastroparesis is.
Gastroparesis is the term used for a neurologic defect in stomach emptying. Typically it’s seen in type 1 diabetes. People have other complications of diabetes, and the nerves to the stomach don’t allow normal coordinated emptying of the stomach. So sometimes your stomach might empty immediately on ingested food; sometimes the food may stay there for hours.
In fact, it’s been documented as long as 24 hours or maybe more but no systematic studies. So it’s quite remarkable, fortunately rare, situation. If you think about it, if you’re trying to control your blood sugars and you have no idea when the food you ate will actually enter the bloodstream, you have quite a difficult time knowing what to do.
It’s a difficult illness to treat. There are some surgical treatments that work for some individuals. There are some drugs, none of which, the drugs like Reglan, which are not that terribly effective, a number of drugs which are in the experimental hopper right now.
I would tell you as a clinician working with people type 1 diabetes, if you’re an even average control, you don’t get to see gastroparesis. Gastroparesis is usually seen in the most difficult, long-term, poorly controlled situations.
Now in type 2 diabetes, there’s something different, which is there is accelerated emptying of the stomach. So part of the reason why people type 2 will tend to see high blood sugars after meals is that the stomachs empty faster than usual, and some of the newer therapies slow that down. That’s not gastroparesis per se, but it’s a neurological change in the stomach.
So, stomach emptying literally refers to the process of the food leaving the stomach into the duodenum, into the small bowel. So the stomach doesn’t digest and stomach begins the process of digestion, it churns the food, it mixes it with stomach acid and then releases the food when the food is ready into the small bowel for the rest of digestion to happen and absorption to begin. There’s no absorption, for example, from the stomach.
About Dr. Einhorn:
Dr. Daniel Einhorn received his undergraduate degree from Yale University, his medical degree from Tufts University School of Medicine, and his internship, residency and fellowship at Harvard Medical School. He served on the faculty of Harvard until coming to San Diego in 1984, and has since been a clinical endocrinologist with Diabetes and Endocrine Associates, Associate Clinical Professor of Medicine (Voluntary) at University of California, San Diego, and, until 2000, the Medical Director of the Diabetes Treatment and Research Center at Sharp Healthcare. He is the Medical Director of the Scripps Whittier Institute Diabetes Program. Dr. Einhorn has held many leadership positions with the Board of the American Association of Clinical Endocrinologists, the American Medical Association's Diabetes Advisory Council and The Endocrine Society. He Chaired the American College of Endocrinology Task Force on the Insulin Resistance Syndrome and the Conference on the Insulin Resistance Syndrome. He has served on the American Diabetes Association (ADA) Managed Care Initiative and on the regional ADA and Juvenile Diabetes Foundation, and as Chair of the Diabetes and Pregnancy Program of San Diego and Imperial Counties. He is a fellow of the American College of Physicians and the American College of Endocrinology. His research and publications cover diabetes prevention and reversal, recognition and treatment of diabetic complications, new technologies, new pharmaceuticals, combination therapies, and clinical decision-making.
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