My Day

I have stayed on my diet for diabetes stomach. Delayed gastric emptying, or gastroparesis, represents the far end of the spectrum of dysmotility disorders collectively referred to as diabetic gastropathy or the diabetic stomach. The diabetic stomach is a manifestation of diabetic autonomic neuropathy. It is characterized by potentially debilitating gastrointestinal symptoms and can also interfere with glucoregulation by contributing to a vicious cycle of delayed emptying of food or oral medications. The result may be late glycemic peaks followed by hyperglycemia and further delays in gastric emptying, or by hypoglycemia secondary to retention of food in the stomach. The goal of treatment of diabetic gastropathy is not only to prevent morbidity by controlling gastrointestinal manifestations, but also to enhance glucoregulation and, thus, better control the basic diabetic process. Herein, strategies are proposed for controlling symptoms and improving glycemic control in patients with manifestations of the diabetic stomach.
My blood glucose is running about 15 points higher. In the morning it is up from 87 to 102. I go to the dr March the 6th. I am also having terrible problems with my bladder. I’m on antibiotics. They make my stomach hurt worse. I haven’t been able to do much in the house today. I washed a few dishes and picked up a few toys. My husband is getting irritable with me for not being able to go places with him.

We have made reservations to go to Chicago for Spring Break. My granddaughter and her boyfriend are chefs there. We look forward to all the good food and eating at the restaurants where they work.  We chose this hotel because it’s downtown and in walking distance of the Chicago Mile. That’s where all the museums and places to see is.

Magnificent Mile

The Magnificent Mile, the northern part of Michigan Avenue between the Chicago River and Lake Shore Drive, is Chicago’s version of the Champs-Elysées: a grand wide boulevard with exclusive shops, museums, restaurants and ritzy hotels.

Shopper’s Paradise

All the big names in shopping are present here, from Disney, Apple and Niketown to Bloomingdales and Saks Fifth Avenue. The wide sidewalks, often adorned with well-maintained flowerbeds are always crowded. The areas around the Magnificent Mile are some of Chicago’s wealthiest.

Landmarks

Architectural landmarks like the John Hancock Center and the Tribune Towercan be found in

Michigan Avenue
Bridge

abundance along the avenue. Building booms in the 1920s, 70s and 90s turned the once low-rise residential street into an economically thriving area bordered by tall skyscrapers.

Michigan Avenue Bridge

Following Daniel Burnham’s plan of 1909, Michigan Avenue was widened to create a thoroughfare able to cope with the growing traffic. In order to connect the avenue with Pine street across the Chicago River, the Michigan Avenue bridge was built in 1920. The beautiful bascule bridge, modeled on the Pont Alexandre III in Paris, allowed traffic to move freely from the busy South Michigan Avenue

Wrigley Building

to the north side of the river, which was renamed to North Michigan Avenue.

Soon after the completion of the bridge construction on the north side started: in 1920 the Drake Hotel at the northern end and the now famous Wrigley building at the southern end of N. Michigan Ave. were completed. They were soon followed by other remarkable buildings, including the Allerton Hotel (1924), the Tribune Tower (1925), the Medinah Athletic Club (1929) and 919 N. Michigan Avenue (1929).

Magnificent Mile

Magnificent Mile’s Sidewalk

In 1947, when the North Michigan Avenue already had become Chicago’s most fashionable street, real estate developer Arthur Rubloff – who had ambitious plans for the avenue – dubbed North Michigan Avenue ‘Magnificent Mile’. The name stuck and in 2001 it was even trademarked.

Building Boom

900 N. Michigan Ave.

A new building boom started in 1969 with the construction of the John Hancock Center, a 100-storey tall residential skyscraper. The tower, situated at the northern end of the avenue, attracted other large buildings, including the nearby Water Tower Place (1976), a tower with more than 100 shops, theaters and restaurants. Another boom started at the end of the 1980s and added some more skyscrapers at the Magnificent Mile, among them the 900 N. Michigan Avenue (1989) and Park Tower (2000).

Old Water Tower

Water Tower and
Magnificent Mile

The oldest building along the Magnificent Mile is the Old Water Tower. The tower was built in 1869 and its castle-like architecture looks a bit out of place in this modern high-rise district. One of the lone survivors of the Chicago Great Fire in 1871, the building symbolizes Chicago’s resilience. It faced demolition several times; in 1906, 1918 and 1948 but each time preservationists were able to save the Water Tower.

A Grand Avenue

Thanks to all the landmarks, the wide and beautiful boulevard and the avenue’s great vistas, at the south end bordered by the Michigan Avenue bridge and at its northern end by Oak Street Bridge, the Magnificent Mile is a unique street that you shouldn’t miss on your visit to Chicago.

I pray all of you with chronic illnesses will have a great week. You can email me at … dtbrents@gmail.com

Low-fiber (low-residue) diet

My stomach is hurting so much this week. I’m having pain and stomach spasms. I plan to try this diet for a month to see if I will get better. Doylene

Low-fiber (low-residue) diet
Original Article: http://www.mayoclinic.com/health/low-fiber-diet/MY00744
Low-fiber (low-residue) diet
Definition

Fiber is the part of fruits, vegetables and grains not digested by your body. A low-fiber diet limits these foods and, in doing so, limits the amount of undigested materials that pass through your large intestine and lessens stool bulk. A low-fiber diet may be recommended for a number of conditions or situations.

A low-fiber diet is sometimes called a restricted-fiber or low-residue diet. Residue simply means any food, including fiber, that isn’t digested and remains in the intestines.
Purpose

Your doctor may prescribe a low-fiber diet if there is narrowing of the bowel due to a tumor or an inflammatory disease; after bowel surgery, or when treatment, such as radiation, damages or irritates the gastrointestinal tract.

As your digestive system returns to normal, you usually can slowly add more fiber back into your diet.
Diet details

A low-fiber diet limits the types of vegetables, fruits, cereals and grains that you can eat. Occasionally, your doctor may also want you to limit the amount of milk and milk products that you can eat. Milk doesn’t contain fiber, but it may leave a residue in the digestive tract and because of your current medical condition temporarily contribute to discomfort or diarrhea.

Because the ability to digest food varies from person to person, the following are guidelines about the types and amounts of foods for a low-fiber diet. Depending on your condition and tolerance, your doctor may recommend a diet that is more or less restricted. Also be sure to read food labels. Foods you might not expect can be high in fiber. For example, some yogurts, ice creams, cereals and even some beverages have added fiber. Look for foods that have no more than 1 gram of fiber in a serving.

The following foods are generally allowed on a low-fiber diet:

Enriched white bread or rolls without seeds
White rice, plain white pasta, noodles and macaroni
Crackers
Refined cereals such as Cream of Wheat
Pancakes or waffles made from white refined flour
Most canned or cooked fruits without skins, seeds or membranes
Fruit and vegetable juice with little or no pulp, fruit-flavored drinks and flavored waters
Canned or well-cooked vegetables without seeds, hulls or skins, such as carrots, potatoes and tomatoes
Tender meat, poultry and fish
Eggs
Tofu
Creamy peanut butter — up to 2 tablespoons a day
Milk and foods made from milk, such as yogurt, pudding, ice cream, cheeses and sour cream — up to 2 cups a day, including any used in cooking
Butter, margarine, oils and salad dressings without seeds
Desserts with no whole grains, seeds, nuts, raisins or coconut

You should avoid the following foods:

Whole-wheat or whole-grain breads, cereals and pasta
Brown or wild rice and other whole grains such as oats, kasha, barley, quinoa
Dried fruits and prune juice
Raw fruit, including those with seeds, skin or membranes, such as berries
Raw or undercooked vegetables, including corn
Dried beans, peas and lentils
Seeds and nuts, and foods containing them
Coconut
Popcorn

If you’re eating a low-fiber diet, a typical menu might look like this:

Breakfast:
1 glass milk
1 egg
1 slice of white toast with smooth jelly
1/2 cup canned peaches

Snack:
1 cup yogurt

Lunch:
1 to 2 cups of chicken noodle soup
Soda crackers
Sandwich of drained tuna with mayonnaise or salad dressing on white bread
Canned applesauce
Flavored water or iced tea

Snack:
White toast, bread or crackers
2 tablespoons creamy peanut butter
Flavored water

Dinner:
3 ounces lean meat, poultry or fish
1/2 cup white rice
1/2 cup cooked vegetables, such as carrots or green beans
1 enriched white dinner roll with butter
Hot tea

Prepare all foods so that they’re tender. Good cooking methods include simmering, poaching, stewing, steaming and braising. Baking or microwaving in a covered dish is another option. Try to avoid roasting, broiling and grilling — methods that tend to make foods dry and tough. You may also want to avoid fried foods and go easy on spices.

Keep in mind that you may have fewer bowel movements and smaller stools while you’re following a low-fiber diet. To avoid constipation, you may need to drink extra fluids. Drink plenty of water unless your doctor tells you otherwise, and use juices and milk as noted.
Results

Eating a low-fiber diet will limit your bowel movements and help ease diarrhea or other symptoms of abdominal conditions, such as abdominal pain. Once your digestive system has returned to normal, you can slowly reintroduce fiber into your diet.
Risks

Because a low-fiber diet restricts what you can eat, it can be difficult to meet your nutritional needs. Therefore you should use a low-fiber diet only as long as directed by your doctor. If you must stay on this diet for a longer time, consult a registered dietitian to make sure your nutritional needs are being met.
References
MY00744 Aug. 13, 2011

© 1998-2012 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. “Mayo,” “Mayo Clinic,” “MayoClinic.com,” “EmbodyHealth,” “Enhance your life,” and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

Gastroparesis

American Diabetes Association logo

For more information, Please visit www.diabetes.org
Gastroparesis

Listen to this page using ReadSpeaker

Gastroparesis is a type of neuropathy (nerve damage) in which food is delayed from leaving the stomach.
This nerve damage can be caused by long periods of high blood sugar.
Delayed digestion makes the management of diabetes more difficult.
It can be treated with insulin management, drugs, diet, or in severe cases, a feeding tube.

Gastroparesis is a disorder affecting people with both type 1 and type 2 diabetes in which the stomach takes too long to empty its contents (delayed gastric emptying). The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged or stops working, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.
What are the symptoms?

Signs and symptoms of gastroparesis include the following:

Heartburn
Nausea
Vomiting of undigested food
Early feeling of fullness when eating
Weight loss
Abdominal bloating
Erratic blood glucose (sugar) levels
Lack of appetite
Gastroesophageal reflux
Spasms of the stomach wall

These symptoms may be mild or severe, depending on the person.
What are the complications?

Gastroparesis can make diabetes worse by making it more difficult to manage blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise.

If food stays too long in the stomach, it can cause problems like bacterial overgrowth because the food has fermented. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.
How is it diagnosed?

The diagnosis of gastroparesis is confirmed through one or more of the following tests:

Barium X-ray
After fasting for 12 hours, you will drink a thick liquid containing barium, which covers the inside of the stomach, making it show up on the X-ray. Normally, the stomach will be empty of all food after 12 hours of fasting. If the X-ray shows food in the stomach, gastroparesis is likely. If the X-ray shows an empty stomach, but the doctor still suspects that you have delayed emptying, you may need to repeat the test another day. On any one day, a person with gastroparesis may digest a meal normally, giving a falsely normal test result. If you have diabetes, your doctor may have special instructions about fasting.
Barium Beefsteak Meal
You will eat a meal that contains barium, which allows the doctor to watch your stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working. This test can help find emptying problems that do not show up on the liquid barium X-ray. In fact, people who have diabetes-related gastroparesis often digest fluid normally, so the barium beefsteak meal can be more useful.
Radioisotope Gastric-Emptying Scan
You will eat food that contains a radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radioisotope is small and not dangerous. After eating, you will lie under a machine that detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach. Gastroparesis is diagnosed if more than half of the food remains in the stomach after two hours.
Gastric Manometry
This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the throat into the stomach. The tube contains a wire that takes measurements of the stomach’s electrical and muscular activity as it digests liquids and solid food. The measurements show how the stomach is working and whether there is any delay in digestion.
Blood tests
The doctor may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels.

To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound.

Upper Endoscopy
After giving you a sedative, the doctor passes a long, thin tube called an endoscope through the mouth and gently guides it down the esophagus into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.
Ultrasound
To rule out gallbladder disease or pancreatitis as a source of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.

How is it treated?

The most important treatment goal for diabetes-related gastroparesis is to manage your blood glucose levels as well as possible. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding.
Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To better manage blood glucose, you may need to try the following:

Take insulin more often
Take your insulin after you eat instead of before
Check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your doctor will give you specific instructions based on your particular needs.
Medication

Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.
Meal and Food Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis has improved. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion — something you don’t need if you have gastroparesis — and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.
Feeding Tube

If other approaches do not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. The feeding tube allows you to put nutrients directly into the small intestine, bypassing the stomach altogether. You will receive special liquid food to use with the tube. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream.

By avoiding the source of the problem (the stomach) and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe.

It is important to note that in most cases treatment does not cure gastroparesis — it is usually a chronic condition. Treatment helps you manage gastroparesis, so that you can be as healthy and comfortable as possible.

American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311 1-800-DIABETES
Copyright 1995-2010, ADA. All rights reserved