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Fact Checked

Diabetes and the Stomach: Away with the Sickness 

Diabetes continues to be a common and debilitating medical condition affecting an estimated one in ten of all adults living in the United States

But did you know that high blood sugars can also damage certain organs and tissues? For example, diabetic neuropathy is a type of nerve damage that occurs from diabetes where nerves in the legs and feet (among others) are damaged and can cause pain, tingling, and numbness. 

This damage can also happen to nerves associated with the digestive system like the vagus nerve. When the vagus nerve becomes damaged, the stomach cannot function properly, and individuals may experience delayed gastric emptying. 

Keep reading to learn more about diabetes and the stomach. 

Delayed Gastric Emptying

Delayed gastric emptying (a.k.a. gastroparesis) is a condition that results in the slowing down or complete stopping of the movement of food from the stomach to the intestines. 

The stomach is made up of muscles that help grind food into smaller chunks and move them to the small intestine where the food is further digested and absorbed into the body. 

In individuals with gastroparesis, these stomach muscles stop working correctly, which leads to delayed digestion and several symptoms and complications. 

Symptoms of gastroparesis may include:

  • Feeling of fullness after only a few bites of food
  • Bloating 
  • Excessive belching
  • Nausea 
  • Nagging ache in the upper abdomen 
  • Vomiting 
  • Heartburn

Gastroparesis, if untreated, may result in serious complications. Individuals may experience malnutrition because of poor food absorption. Food can accumulate in the stomach and form blockages, leading to even more problems over time. 

Individuals with gastroparesis tend to have worse control over their health conditions because of the delayed absorption of crucial medications. Diabetes is notoriously difficult to control in individuals who develop gastroparesis. Accompanying nausea, vomiting, and other symptoms may drastically reduce quality of life.

Gastroparesis occurs in 1 out of every 2,000 US adults, and it is most common among people with diabetes. 

Thankfully, appropriate options are available to treat this debilitating condition. The Food and Drug Administration (FDA) recently approved a new formulation of a commonly used medication to help control gastroparesis. 

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Metoclopramide

Metoclopramide was previously approved by the FDA in 1979 and has been the drug of choice for the treatment of gastroparesis.

It has been studied extensively in the past decades. Metoclopramide has been shown to reduce symptoms of gastroparesis, such as nausea and vomiting, by between 30–50%; this means that after a month of treatment, individuals may report that they experienced up to half as many of their usual symptoms.

Metoclopramide works by blocking dopamine receptors in your body. It is unclear how this mechanism factors into increasing stomach motility, but it helps to relieve many of the debilitating symptoms of gastroparesis. Metoclopramide also helps stimulate stomach muscle contractions and promote the movement of stomach contents to the small intestine.

The problem with giving an oral drug to an individual suffering from gastroparesis is that some people cannot swallow the medication because of accompanying nausea. Even if swallowed, the drug may remain in the stomach and not get absorbed because of the delayed gastric emptying. 

In with the New - Introducing Gimoti

Gimoti™ is a new prescription-only formulation of metoclopramide that bypasses the mouth altogether and is administered as a nasal spray. 

Great, so does the nasal spray offer any additional benefit over the oral formulation? 

It does appear that the new formulation is beneficial since more patients reported symptom relief after using the nasal spray compared to those that used the oral formulation. Almost 9 in 10 patients reported improvement with the oral formulation, while patients using the nasal spray saw almost 100% relief of symptoms.

Gimoti™ is administered as single spray in one nostril, 30 minutes before each meal and at bedtime. It is recommended not to take more than 4 sprays per day. 

Individuals who have been prescribed Gimoti™ by their primary healthcare provider should only use it for as long as they have symptoms, ideally for 2 to 8 weeks. No form of metoclopramide should be taken for longer than 12 weeks because it may cause a movement disorder called tardive dyskinesia. This condition may be irreversible, but the risk increases with the collective dose of metoclopramide. 

Patients who are 65 years of age and older should not start Gimoti™ unless they have been on an alternative version of metoclopramide previously. 

Patients should avoid medications that can worsen gastric emptying if they suffer from gastroparesis and while taking Gimoti™. Examples of medications that slow down gastric emptying include opioids, like morphine, and allergy medications like antihistamines.  

Patients should also not use any form of metoclopramide if they have a history or are currently experiencing any of the following: 

  • Tardive dyskinesia
  • Pheochromocytoma, a tumor that releases adrenaline
  • Seizures 
  • There is a prior history of allergy to metoclopramide
  • Depression
  • Thoughts of suicide
  • If the stimulation of stomach motility might be dangerous

The most common side effects of Gimoti™ include:

  • Headache
  • Fatigue
  • Altered sensation of taste

Before Gimoti™ is considered for the treatment of gastroparesis, make sure you speak with your primary healthcare provider to learn more and determine if it is an appropriate medication for you.

Bottom Line

Gastroparesis is a common condition associated with diabetes that can worsen health and reduce quality of life. 

Gimoti™ is a new metoclopramide prescription nasal spray that may benefit individuals with gastroparesis who can’t easily swallow or properly absorb medications. 

Gimoti™ should be taken with caution and for no more than 12 weeks. Ideally, the duration of treatment should be based on decreases in symptoms, which tends to take 2-8 weeks. 

If you are considering taking Gimoti™, make sure you speak with your primary healthcare provider who can provide medical advice and determine if this new prescription drug is appropriate.

Reference List

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2020. Accessed August 25, 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
  2. Diabetes Symptoms. Centers for Disease Control and Prevention. Updated March 24, 2020. Accessed August 25, 2020. https://www.cdc.gov/diabetes/basics/symptoms.html
  3. Gastroparesis: Definitions and Facts. National Institute of Diabetes and Digestive and Kidney Disease. January 2018. Accessed August 25, 2020. https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/definition-facts
  4. Gastroparesis. Jackson-Siegelbaum Gastroenterology. Updated September 12, 2018. Accessed August 25, 2020. https://www.gicare.com/gi-health-resources/gastroparesis/
  5. FDA Approves Evoke’s GIMOTI™. GlobeNewswire. June 19, 2020. Accessed August 25, 2020. https://www.globenewswire.com/news-release/2020/06/19/2050830/0/en/FDA-Approves-Evoke-s-GIMOTI.html
  6. Lee A, Kuo B. Metoclopramide in the treatment of diabetic gastroparesis. Expert Rev Endocrinol Metab. 2010;5(5):653-662. doi:10.1586/eem.10.41
  7. Gimoti™. Prescribing information. Evoke Pharma, Inc; 2020. Accessed August 25, 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/209388s000lbl.pdf
  8. Parkman HP, Carlson MR, Gonyer D. Metoclopramide nasal spray is effective in symptoms of gastroparesis in diabetics compared to conventional oral tablet. Neurogastroenterol Motil. 2014;26(4):521-528. doi:10.1111/nmo.12296
  9. Gastroparesis: Treatment. National Institute of Diabetes and Digestive and Kidney Disease. January 2018. Accessed August 25, 2020. https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/treatment
Published September 10th, 2020 by Dr. Tomasz Jurga, PharmD, BCPS, BCACP, CDCES
Fact Checked by Chris Riley

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