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Diabetes and Neuropathy

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Gastroparesis and Diabetes: Another Aspect of Neuropathy
Posted on June 26, 2015 by Joslin Communications
This entry was posted in Complications, Diabetes Day2Day and tagged gastroparesis, neuropathy. Bookmark the permalink.
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Patients with long standing diabetes usually have some evidence of damage to the nervous system, or neuropathy. If you have neuropathy you may be familiar with pain, tingling, numbness or loss of feeling in the feet or hands (called peripheral neuropathy), but it can affect any organ system, including the stomach and its related organs.

Nerve damage associated within the gastrointestinal tract can result in the motility disorders of gastroparesis and small bowel bacterial overgrowth (SBBO). Gastroparesis is 2 to 3 times more common in type 1 diabetes than type 2 diabetes and may affect as many as 50 percent of those with type 1.

If you eat a low-fat, mixed meal your blood glucose will peak in about 1.5 hours. With normal bowel function, this peak coincides with the peak action of rapid acting insulin.

But damage to the nerves (the vagus nerve) of the gastrointestinal tract causes a loss of stomach and intestinal motor control. This can lead to a mismatch between when you digest food and glucose enters the blood stream and the action time of insulin.

If you have gastroparesis you may experience erratic blood glucose, with a pattern of low glucose readings shortly following the meal and elevated readings hours after eating.

Symptoms include nausea, early satiety, vomiting and in severe cases weight loss. Because of gastric stasis and slower bowel transit times, patients are also prone to constipation.

Gastroparesis is diagnosed by gastric emptying studies. In this test, patients are fed a meal containing a marker isotope and x-ray pictures are taken of the stomach over a 4 hour period.

Severe gastroparesis can lead to malnutrition due to continued vomiting and poor consumption of calories and protein. The goals of nutrition therapy are to prevent muscle loss, provide adequate vitamin and mineral intake, control blood glucose levels and relieve symptoms.

Nutrition recommendations include

1. Eat smaller, more frequent meals;

2. Consume more of your calories with liquids. Liquids pass more quickly than solids through the stomach;

3. Limit dietary fiber especially, for patients prone to bezoars (those are hairball like accumulations of hardened food fibers, and they can lead to obstruction of the passage from the stomach to the intestine)

4. Reduce dietary fats –especially solid fats – as they delay gastric emptying. Fats in liquid form appear better tolerated

5. Consume adequate calories to achieve or maintain a healthy weight

Other recommendations include:

1. Control of blood glucose- high levels (greater than 270 mg/dl) delay GI transit time.

2. Taking insulin after the meal or for patients using an insulin pump, use the extended action bolus.

3. Using a combination of prokinetic (movement stimulating) and antiemetic (anti nausea and vomiting) agents to improve gastric motility and control symptoms of nausea and vomiting.

For patients who do not find relief with the above measures, gastric electric stimulation can be attempted. A small pulse generator is placed under the skin and wires are attached to the stomach. The generator emits a small charge stimulating stomach emptying.

But, as always, talk to your doctor before making any changes to your diet or care.

More information about gastroparesis can be found on the NIH website.

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What is an Invisible Disability?

March30,2016
What is an Invisible Disability?
Invisible Disabilities Association – InvisibleDisabilities.org

By Guest Blogger Wayne Connell, Founder, Invisible Disabilities Association

What is an “invisible disability?” Is it a specific illness or condition, such as multiple sclerosis, fibromyalgia, bipolar disorder, diabetes, a Chiari malformation or syringomyelia? Is it the symptoms of an illness or disability, such as pain or fatigue or neuropathy or brain fog? Why do we even use the phrase or where did it come from? Isn’t a disability just a disability, no matter if you can see it or not? Are people treated differently because their disability manifests itself visibly? Is having a disability different from being disabled? All great questions! Is someone, who has an illness or is in pain or has a disability or is disabled, a bad person who should be treated like a lesser human? I can answer that one. NO!

Twenty years ago in 1996, my wife, Sherri, coined the term “invisible disability.” Why did she come up with it? After receiving a diagnosis of primary progressive multiple sclerosis and chronic late stage Lyme disease in 1991, at the young age of 27, Sherri endured the stares and accusations and disbelief of strangers and friends that questioned how she could be disabled and still walk with seemingly unapparent outward signs of her disabilities. People would often scream at her when she parked in an accessible space or ignore her when she collapsed on the floor of a department store. So the phrase, “I have an invisible disability,” became an apt description of what she was living with.

As a tech guy, I decided to use some of Sherri’s pamphlets she wrote to help friends and family better understand what she was going through such as “Multiple What? Untangling the Perplexities of Multiple Sclerosis” and “Don’t Judge by Appearances – Parking with Invisible Disabilities” and created the InvisibleDisabilities.org website. That is when The Invisible Disabilities Advocate® was launched (which became the Invisible Disabilities® Association (IDA)). Almost immediately, 25,000 people a month started coming to IDA’s website and said that we put into words what they had been trying to tell their friends and families. “Invisible disabilities” progressed from a very descriptive term to an international organization and movement.

Of course, the question most-asked of our organization is, “what is an ‘invisible disability?’” In general, the term “disability” is often used to describe an ongoing physical challenge. This could be a bump in life that can be well-managed or a mountain that creates serious changes and loss. Either way, this term should not be used to describe a person as weaker or lesser than anyone else! Every person has a purpose, special uniqueness and value, no matter what hurdles they may face.

In addition, just because a person has a disability does not mean they are disabled. Many living with these challenges are still fully active in their work, families, sports or hobbies. Some with disabilities are able to work full or part time, but struggle to get through their day, with little or no energy for other things. Others are unable to maintain gainful or substantial employment due to their disability, have trouble with daily living activities and/or need assistance with their care.

According to the Americans with Disabilities Act of 1990 (ADA), an individual with a disability is a person who: has a physical or mental impairment that substantially limits one or more major life activities; has a record of such an impairment; or is regarded as having such an impairment.

Furthermore, “A person is considered to have a disability if he or she has difficulty performing certain functions (seeing, hearing, talking, walking, climbing stairs and lifting and carrying), or has difficulty performing activities of daily living, or has difficulty with certain social roles (doing school work for children, working at a job and around the house for adults).”

Often people think the term “disability” only refers to people using a wheelchair or walker. On the contrary, the 1994-1995 Survey of Income and Program Participation (SIPP) found that 26 million Americans (almost one in 10) were considered to have a severe disability, while only 1.8 million used a wheelchair and 5.2 million used a cane, crutches or walker. In other words, 74 percent of Americans who live with a severe disability do not use such devices. Therefore, a disability cannot be determined solely on whether or not a person uses assistive equipment.

The term “invisible disability” refers to symptoms such as debilitating pain, fatigue, dizziness, cognitive dysfunctions, brain injuries, learning differences and mental health disorders, as well as hearing and vision impairments. These are not always obvious to the onlooker, but can sometimes or always limit daily activities, range from mild challenges to severe limitations and vary from person to person.

Also, someone who has a visible impairment or uses an assistive device such as a wheelchair, walker or cane can also have an invisible disability. For example, whether or not a person utilizes an assistive device, if they are debilitated by such symptoms as described above, they live with an invisible disability.

Unfortunately, people often judge others by what they see and often conclude a person can or cannot do something by the way they look. This can be equally frustrating for those who may appear unable, but are perfectly capable, as well as those who appear able, but are not.

International Disability expert Joni Eareckson Tada explained it well when she told someone living with debilitating fatigue, “people have such high expectations of folks like you [with invisible disabilities], like, ‘come on, get your act together.’ But they have such low expectations of folks like me in wheelchairs, as though it’s expected that we can’t do much.”

The bottom line is that everyone with a disability is different, with varying challenges and needs, as well as abilities and attributes. Thus, we all should learn to listen with our ears, instead of judging with our eyes.

At the Invisible Disabilities® Association, we do not maintain a list of specific illnesses and diagnoses that are considered invisible disabilities. There are thousands of illnesses, disorders, diseases, dysfunctions, genetic defects, impairments and injuries that can be debilitating. Therefore, all conditions that are debilitating are included when we talk about invisible disabilities. However, our focus is not to attempt to provide a vast amount of information about thousands of specific conditions (there are plenty of amazing organizations that do that).

IDA is here to provide awareness, education, connection and support for everyone who lives with a debilitating condition. We do this by offering articles, pamphlets, books, resources, radio interviews, video, seminars, symposiums and more to give hope and compassion to all living with invisible disabilities as well as information for loved ones to better understand.

IDA’s mission is to encourage, educate and connect people and organizations touched by illness, pain and disability around the globe. Hard to believe it has been twenty years yet there is still so much more work to do. Will you join us on this journey and envision a world where people living with illness, pain and disability will be Invisible No More®?
About the Guest Blogger

Wayne Connell, the founder and president of the Invisible Disabilities® Association (IDA), established IDA twenty years ago in 1996 out of the desire to educate friends and family about his wife’s debilitating illness. Soon afterwards, people around the globe began sending emails sharing how IDA had changed their relationships with their loved ones. He is co-author of the book, “But You LOOK Good, How to Encourage and Understand People Living with Illness and Pain.” Wayne’s background fueled his passion for helping people living with illness, pain and disability. His experience includes that of a professional, multitasking husband caregiver with an extensive background in management, media and technology. This man on a mission quickly launched IDA into a world-wide outreach for millions living with invisible disabilities.

Make sure you check out IDA’s website for additional resources and stories at www.InvisibleDisabilities.org. Share your personal video story with us at www.InvisibleNoMore.tv. You can also be part of other people’s stories by joining them at www.Facebook.com/invisibledisabilities or becoming a member of InvisibleDisabilities.Inspire.com. Join IDA at our 2nd annual Brain IDEAS Symposium on August 5th. Invisible Disabilities Week is Oct 16 through 22, 2016. Our 9th Annual Awards Gala, “Jazzed About You” will be Octob

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