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May 5, 2010

Complications, Other Medications

Question from Pembroke Pines, Florida, USA:

My daughter was diagnosed with type 1 diabetes at the age of 11. We have had an upward battle since then. Four months ago, she was diagnosed with gastroparesis. She lost a lot of weight and became severely malnourished. The doctors placed a feeding tube through her stomach as she was unable to eat enough to sustain herself. Even with the tube in place, due to the gastroparesis, she was still having difficulties. I feel certain that she can't be the only diabetic with this condition and wondered if anyone has come up with a more effective way of treating this and have there been any successes?

Answer:

You and your daughter are not alone. Gastroparesis is a very severe and troublesome complication of diabetes. It is very hard to treat. Most of the medications that work initially have the problem of losing their effect over time. Our gastroenterologists have had some success with Domperadone, a medication not approved here in the United States but available on compassionate plea basis. Other medications that have been used include Reglan, erthromycin, and other anti-emetics. There have also been studies to look at upper GI pacemakers that attempt to stimulate the natural rhythm of the gut activity to move food through the esophagus and stomach. Unfortunately, the approach to therapies is emperic. This means you try something and if that doesn’t work, you try something else. In addition, there are all kinds of problems trying to anticipate the peak glucose after meals and deciding when to give bolus insulin. This problem is definitely best treated by a specialist in the area, especially when easy things don’t work.

JTL