June 29, 2005
Complications
Question from Georgia, USA:
I am a type 1 diabetic and was recently diagnosed with diabetic gastroparesis despite my tight control with my sugars. Now, with the gastroparesis, it makes me vomit after meals and really nauseous a lot. I eat, then take one unit of Humalog for every 13 grams of carbohydrates. About one to two hours later, I vomit and end up with a low sugar ranging from 35 to 50 mg/dl [1.9 to 2.8 mmol/L]. How can I stop the lows without compromising my diabetes care? I also take 40 units of Lantus at bedtime. For the gastroparesis, they gave me Reglan and phenergan, but I was told the phenergan causes elevated sugars as well so I try to not take it. I was thinking that switching to the sliding scale would help, but wanted a second opinion before I spoke with my doctor next week.
Answer:
Diabetic gastroparesis is a form of diabetic neuropathy. It certainly makes your diabetes very difficult to treat. Sometimes, the medication Reglan helps when taken before meals and at bedtime. In addition, taking the insulin after meals, as you suggest, prevents the lows that may occur when food does not move through the gastrointestinal tract. Patients placed on insulin pumps have a function on the pump called the square wave bolus that allows their insulin bolus at meals to be given over a matter of hours, rather than as one large bolus. This helps cut down on the lows. Whether you are a pump candidate is up to you and your physician. You might also ask your doctor about other medications that may help with the nausea.
JTL
