From the Research
Paralytic ileus in diabetic patients is best treated with a combination of supportive care, addressing underlying causes, and considering the use of prucalopride as a prokinetic agent, as evidenced by the most recent study in 2021 1. The management of paralytic ileus in patients with diabetes mellitus (DM) involves a multifaceted approach. Initial management includes:
- Bowel rest with nothing by mouth (NPO)
- Intravenous fluid resuscitation to correct electrolyte imbalances (particularly potassium, magnesium, and phosphate)
- Nasogastric tube decompression to relieve abdominal distension and prevent vomiting Blood glucose control is crucial, typically using insulin infusion to maintain levels between 140-180 mg/dL, as chronic hyperglycemia contributes to autonomic neuropathy affecting gut motility 2. Medications that slow gut motility should be discontinued, including opioids, anticholinergics, and calcium channel blockers. Prokinetic agents may be considered once the acute phase resolves, such as metoclopramide or erythromycin, but prucalopride has shown efficacy in improving bowel dilatation and abdominal circumference in critically ill patients with paralytic ileus, making it a potential option for diabetic patients as well 1. For diabetic patients specifically, optimizing long-term glucose control is essential to prevent recurrence. Nutritional support may be required if ileus persists beyond 3-5 days, typically via parenteral nutrition initially 3. Surgery is rarely needed but may be considered if there is no improvement after 72 hours of conservative management or if mechanical obstruction is suspected 4. The underlying pathophysiology involves impaired intestinal motility due to diabetic autonomic neuropathy, metabolic derangements, and inflammation, all of which must be addressed for effective treatment.