What Is Diabetic Gastroparesis?

Diabetic gastroparesis is one of the most common and challenging complications of diabetes, yet many people have never heard of it. Diabetic gastroparesis can happen when high blood sugar damages the nerves that control the stomach, which slows or even stops the normal movement of food into the small intestine.

"By far the most common cause of gastroparesis is diabetic neuropathy," said Franciscan Health gastroenterologist Mohammad Arfeen, DO. "People get numbness and tingling in their hands and feet when elevated blood sugars attack the nerves over time. Those same sugars can damage the nerves that control the stomach's ability to move and empty food properly (motility)."

That nerve damage leads to decreased motility, poor emptying and sometimes spasms of the pylorus — the ring at the exit of the stomach, he said.

Understanding diabetic gastroparesis is key for patients and families to manage diabetes, since the condition can make both eating and blood sugar control more difficult.

Key Takeaways: Diabetic Gastroparesis

• Nerve damage from diabetes can contribute to digestion slowing.
• Diabetic gastroparesis symptoms can overlap with other digestive issues.
• Treatment approaches can help relieve symptoms and improve overall blood sugar control.

What Are The Symptoms Of Diabetic Gastroparesis?

Diabetic gastroparesis symptoms can look different in each person. Some patients experience nausea that never lets up, vomiting multiple times a day or a constant sense of fullness that makes it difficult to eat. Others only have symptoms after certain meals or foods. And for some, episodes come and go.

In addition to nausea and vomiting, many also deal with:

• Abdominal pain or bloating
• Feeling full quickly, even after a small meal
• Heartburn or reflux
• Poor appetite or unintentional weight loss

Dr. Arfeen said that symptoms often flare with poorly controlled blood sugars.

"Many of my patients describe a constant sense of fullness," he said. "It's not just an inconvenience — it affects how much they can eat, their ability to get nutrients and sometimes even makes blood sugar harder to control."

Why Does Diabetes Cause Gastroparesis?

The connection between diabetes and gastroparesis is due to nerve damage. Long-term high blood sugar injures the vagus nerve, which regulates stomach emptying. When the vagus nerve doesn't work properly, the stomach muscles don't contract as they should, and digestion slows.

This delayed emptying can trigger nausea, bloating or vomiting, and also makes blood sugar control unpredictable. Patients may take insulin and expect food to digest normally. But if the stomach is slow to empty, blood sugar may drop too low, then spike hours later when digestion finally happens.

How Is Diabetic Gastroparesis Diagnosed?

Diagnosis begins with a careful review of symptoms and medical history, especially in patients with long-standing diabetes. Additional tests may include:

• Gastric emptying study: This is the most common test. Patients eat a small meal with a safe tracer. Imaging shows how quickly food leaves the stomach.
• Upper gastrointestinal endoscopy: This test helps rule out blockages or structural issues.
• Imaging scans: Providers may order CT, MRI and X-rays if they suspect another digestive problem.

Dr. Arfeen said that diagnosis is important because diabetic gastroparesis symptoms often overlap with other digestive issues. This makes it easy to miss without testing.

Treatment And Lifestyle Changes That Help

Management of diabetic gastroparesis is about more than symptom control. It's also about how to prevent future complications. If left untreated, the condition can impact nutrition, weight and quality of life. Ongoing nausea, bloating or vomiting often affects mood and energy. Poor nutrition can lead to weight loss, muscle weakness and even osteoporosis.

Treatment usually begins conservatively.

"The first priority is to keep blood sugar under control to reduce nerve damage and stabilize symptoms," Dr. Arfeen said. "Dietary adjustments are also key. Instead of three large meals, many patients do better with five or six small meals — about the size of a fist — every few hours."

This helps reduce the burden on the stomach and makes symptoms more manageable.

Other treatment options may include:

• Medications: Short courses of medications can help reduce nausea or stimulate the stomach to empty. These aren't ideal long-term, but can be useful during symptom flare-ups.
• Referral to specialists: Gastroenterologists may recommend advanced treatments if symptoms don't improve with diet and medications.

If you have persistent symptoms, we may consider advanced therapies. One  treatment option is gastric peroral endoscopic myotomy (G-POEM), a minimally invasive procedure that improves stomach emptying. Your gastroenterologist may recommend other treatments, such as gastric electrical stimulation.

"Diabetic gastroparesis doesn't have a one-size-fits-all solution," Dr. Arfeen said. "But with a personalized approach, most patients feel better and can stabilize their blood sugar."

The best protection is prevention. Lower your risk of developing diabetes or keep diabetes under control to help protect the nerves that regulate stomach function.

When To See A Doctor

If you have diabetes and notice ongoing nausea, vomiting, bloating or trouble controlling your blood sugar, it may be time to talk with a gastroenterologist.

Franciscan Health offers comprehensive testing and treatment for diabetic gastroparesis, with specialists who understand how closely it ties to blood sugar management.

Learn more about gastroparesis and advanced treatments, including G-POEM. Or talk with your doctor about scheduling an appointment with one of our gastroenterologists.