From the Guidelines
Diabetic gastroparesis is the medical term for chronic vomiting associated with diabetes, and its treatment typically involves a multi-faceted approach including dietary modifications, blood glucose control, and medications, with metoclopramide being the only FDA-approved medication for this condition, as stated in the most recent study 1. The condition occurs when nerve damage from prolonged high blood sugar levels affects the stomach muscles, slowing or stopping food movement from the stomach to the small intestine.
- Patients should eat smaller, more frequent meals that are low in fat and fiber, as recommended by the 2024 study 1.
- Medications commonly prescribed include antiemetics like ondansetron (4-8mg every 8 hours as needed) or promethazine (12.5-25mg every 4-6 hours), and prokinetic agents such as metoclopramide (10mg before meals and at bedtime) or erythromycin (250mg three times daily before meals), as suggested by the 2022 study 1.
- For severe cases, domperidone (10mg up to four times daily) may be used where available, as mentioned in the 2020 study 1.
- Blood glucose management is crucial, as improved glycemic control can reduce symptoms, as emphasized in the 2021 study 1.
- In treatment-resistant cases, more advanced interventions like gastric electrical stimulation or surgical options might be considered, as discussed in the 2022 study 1.
- Staying well-hydrated and avoiding alcohol, smoking, and high-fat foods can help manage symptoms, as recommended by the 2023 study 1. This condition requires ongoing management as it's typically chronic in nature, and the treatment approach should be individualized based on the patient's specific needs and response to therapy, as highlighted in the most recent study 1.
From the FDA Drug Label
Metoclopramide is a prescription medicine used to: • relieve symptoms of slow stomach emptying in people with diabetes • prevent nausea and vomiting that can happen with cancer chemotherapy • prevent nausea and vomiting that may happen after surgery, if your doctor decides that you should not be treated with a stomach tube and suction • help make it easier to insert a tube into the small intestine in both adults and children, if the tube does not pass into the stomach normally. • to help empty stomach contents or to help barium move through your intestine, when you get an X-ray examination of the stomach or small intestine.
The medical term for diabetes involving chronic vomiting is Diabetic Gastroparesis. The treatment for diabetic gastroparesis is metoclopramide, which is used to relieve symptoms of slow stomach emptying in people with diabetes 2. Key points about the treatment:
- Metoclopramide is a prescription medicine used to relieve symptoms of slow stomach emptying in people with diabetes.
- It can also be used to prevent nausea and vomiting that can happen with cancer chemotherapy or after surgery.
- The dose of insulin may need to be changed when taking metoclopramide, as it can affect the delivery of food to the intestines and thus the rate of absorption 2.
From the Research
Definition and Symptoms of Diabetic Gastroparesis
- Diabetic gastroparesis is a complication of long-standing type 1 and type 2 diabetes mellitus, characterized by delayed gastric emptying without mechanical obstruction 3.
- Symptoms associated with gastroparesis include nausea, vomiting, early satiety, prolonged postprandial fullness, bloating, and abdominal pain 3, 4.
- The cardinal symptoms of diabetic gastroparesis are nausea and vomiting 5.
Diagnosis of Diabetic Gastroparesis
- The diagnosis of diabetic gastroparesis is made by documenting the presence of chronic upper gastrointestinal (GI) symptoms, ruling out mechanical obstruction, and demonstrating delayed gastric emptying 4.
- Gastroesophageal scintiscanning at 15-minute intervals for 4 hours after food intake is considered the gold standard for measuring gastric emptying 5.
- Retention of more than 10% of the meal after 4 hours is considered an abnormal result, for which a multidisciplinary management approach is required 5.
Treatment of Diabetic Gastroparesis
- Treatment should be tailored according to the severity of gastroparesis, and 25% to 68% of symptoms are controlled by prokinetic agents 5.
- Commonly prescribed prokinetics include metoclopramide, domperidone, and erythromycin 5, 6.
- Metoclopramide remains the only drug approved by the Food and Drug Administration for diabetic gastroparesis 7.
- Gastric electrical stimulation has been shown to improve symptoms, reduce hospitalizations, reduce the need for nutritional support, and improve quality of life in several open-label studies 5.
- Current treatment approaches also include improving glucose control with insulin and prescribing antinauseant drugs 3.
- Emerging treatment options, such as gastric neurostimulation, are encouraging 4.