Savvy “Tough Topics” 10/20/21: GREAT TALK on Gastric/Digestive Issues and Type 1 Diabetes

Gastric and Digestive STUFF make up some of the most unpleasant complications of T1D and no one really mentions them, no less wants to talk about them. And they absolutely impact how we T1Ds absorb food and how we need to adapt our bolus strategies, as well as how we feel and function throughout the day and how we cope.

Though gastrointestinal (GI) complications are common in longstanding diabetes, changes in the gut begin as early as 6 months after diagnosis of Type 1 diabetes, even in young children. And the awareness of these complications is low among physicians. Early identification and appropriate management of GI complications are important for improving both diabetic management and quality of life.

Dr. Marina Basina is Clinical Professor of Medicine, Endocrinology, Gerontology and Metabolism, Stanford University. She is a clinical endocrinologist and clinical researcher with a focus on diabetes management, thyroid, and adrenal conditions. Her primary interests are in Type 1 Diabetes, Diabetes technology, and Diabetes in pregnancy. Dr. Basina is Board certified in Endocrinology and Internal Medicine. She received numerous teaching awards and the Stanford Hospital award for excellence in patient care. As if she weren’t already busy enough, she is an active member of medical advisory boards for several community diabetes organizations as well as a medical director of inpatient diabetes program at Stanford and a chair of the diabetes task force.

Dr. Linda Nguyen is Clinical Professor, Medicine – Gastroenterology & Hepatology at Stanford University, with special interests: Gastroparesis, Chronic Nausea, Cyclic Vomiting, Irritable Bowel Syndrome, Autonomic dysfunction, and Brain-gut disorders.

She has said, “Food has always been a big part of my life. Imagine what life would be like if eating made you sick? Because we need food to survive and we are social creatures who revolve much of our lives around food, not being able to eat impacts physical, mental and social well-being. It is this intricate interconnection between the brain and the gut which drew me to the field of Neurogastroenterology & Motility. My research includes understanding the role/impact of physiologic testing on clinical care, exploring novel therapies for gastroparesis, and expanding the role of neuromodulation in the treatment of GI motility disorders and pain.”

What’s so special about this area of research?

There is growing evidence that there is a strong relationship between Type 1 diabetes and the gut microbiome. In fact, the gut microbiome might be a pivotal hub of T1D‐triggering factors. Interesting, huh?

I asked Dr. Rayhan Lal, pediatric and adult endocrinologist at Stanford University School of Medicine, as well as a T1D and brother of 2 T1D sisters, about the issues of gastric complications in longstanding diabetes: It’s such a horrible quality of life and the symptoms are miserable. The other issue is that it doesn’t always correlate with glycemic control in the same way as other microvascular complications. Additionally, gastric emptying time does not always correlate with symptoms so very hard to know how to gauge treatment.

This was a very special, informative, and caring event, packed with important and useful information. Please feel free to share this recording with others, and particularly with your medical/healthcare professionals. The Stanford University protocol for treating patients with GI includes the following HCPs: Primary Care, Endocrinologist, CDE, Dietitician, Psychologist and others.

I’m sure this video may bring up LOTS of questions! Be sure to ask in Comments below or on the YouTube Comments section … I’ll forward the questions to Dr. Basina and Dr. Nguyen.

If you’d like to see some of the questions brought up in the Chat during the live event: https://docs.google.com/document/d/1ta1NiYrCXDNFFeJ70uQ5YPYABjKH0SMT9KJ4eS2R-6M/edit?usp=sharing

Here are some interesting links, shared by Anne Burkley, a member of the Loop and Learn FB Group, about the microbiome triggering T1D, as well as a study about probiotics. I can’t comment on these other than to share information.