From the FDA Drug Label
For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis) If only the earliest manifestations of diabetic gastric stasis are present, oral administration of metoclopramide may be initiated.
The best initial treatment for gastroduodenitis in a type 1 diabetic with gastroparesis is oral administration of metoclopramide if only the earliest manifestations of diabetic gastric stasis are present 1.
- Key considerations:
- The patient's condition and the severity of symptoms should be assessed before initiating treatment.
- The physician should make a thorough assessment of the risks and benefits prior to prescribing metoclopramide treatment.
- Patients with diabetes may require adjustment of their insulin dose when taking metoclopramide 1.
- Important safety information: Metoclopramide can cause serious side effects, including abnormal muscle movements called tardive dyskinesia (TD), and parkinsonian-like symptoms 1, 1.
From the Research
The best initial treatment for gastroduodenitis in a type 1 diabetic with gastroparesis is a multifaceted approach focusing on both conditions simultaneously, starting with a proton pump inhibitor (PPI) and a prokinetic agent, along with strict glycemic control and dietary modifications. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of managing both gastroparesis and diabetes simultaneously 2.
Key Components of Treatment
- Proton Pump Inhibitor (PPI): Such as omeprazole 20-40 mg once daily or pantoprazole 40 mg once daily before breakfast to reduce gastric acid production and promote healing of the inflamed gastroduodenal mucosa.
- Prokinetic Agent: Like metoclopramide 5-10 mg three times daily before meals (limiting use to 12 weeks due to risk of tardive dyskinesia) or domperidone 10 mg three times daily before meals (where available) to manage gastroparesis symptoms.
- Strict Glycemic Control: Essential, as hyperglycemia can worsen gastroparesis symptoms, and improved glycemic control can help break the cycle of gastroparesis symptoms and poor diabetes management 3.
- Dietary Modifications: Crucial, including small, frequent, low-fat, low-fiber meals, and avoiding foods that delay gastric emptying.
- Lifestyle Changes: Patients should also avoid NSAIDs, alcohol, and smoking which can exacerbate gastroduodenitis.
Rationale
The treatment approach is based on the understanding that gastroparesis in type 1 diabetes is a component of autonomic neuropathy resulting from long-standing poorly controlled diabetes 3. Managing both conditions simultaneously is crucial for improving symptoms and quality of life. While older studies provide foundational knowledge on the diagnosis and treatment of gastroparesis in diabetes 4, 5, the most recent study 2 reinforces the importance of a multifaceted approach to treatment, emphasizing the need for current and comprehensive management strategies. Additionally, considerations regarding the effect of proton pump inhibitors on glycemic control in patients with type 2 diabetes 6 highlight the complexity of managing gastrointestinal symptoms in diabetic patients, further supporting the need for a tailored approach that considers the specific needs of type 1 diabetic patients with gastroparesis.