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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The author discusses abnormalities in gastric emptying due to diabetes mellitus, and in particular, diabetic gastroparesis, on the basis of his own experience and the relevant literature. Diabetic gastroparesis is a result of a diabetic neuropathy of the vagus. Even in the presence of mild abdominal symptoms, particularly with repeated hypoglycaemic episodes, this condition should be considered and the stomach should be examined readiologically. A diabetic phytobezoar may develop. It may be presumed that these changes are more common than had previously been realized. The author has observed six cases. The gastric atony associated with diabetic coma has to be differentiated from the condition under discussion. Conservative treatment is recommended.
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PMID:[Disturbance of gastric emptying in diabetes mellitus (author's transl)]. 12 11

Gastroparesis diabeticorum has been isolated by Kassander in 1958. Since that time, 65 well documented cases have been published. Very often the patients are asymptomatic and the disorder is discovered by an occasional X-ray examination of the G-I tract. But, sometimes, the diabetes of these patients becomes brittle and they loose weight; bezoar, gastroplegia and hemorrhages may occur. We report two additional cases with severe undernutrition and bezoar. The gastroparesis may be related to a vagal neuropathie. The treatment is disappointing; metoclopramide gives the best improvement.
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PMID:[Gastroparesis diabeticorum and bezoar (author's transl)]. 21 38

A case of severe diabetic steatorrhoea is presented in a young Black male with poorly controlled diabetes, symptomatic peripheral neuropathy, evidence of autonomic neuropathy with gastroparesis and raised faecal fat excretion. A pancreatic function test was negative as were tests of small-bowel structure and function. There was resistance to all therapy. The literature on diabetic diarrhoea and steatorrhoea has been reviewed, and it is concluded that they are expressions of the same entity which remains a clinical problem for which there is at present no effective management.
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PMID:Diabetic diarrhoea and steatorrhoea. A case report and review of the literature. 45 87

Three patients with uncontrolled diabetes mellitus and with symptoms due to gastric retention proved to have gastroparesis diabeticorum. The diagnosis was established by the beefsteak-barium meal. After the administration of metoclopramide, gastric emptying improved and the diabetes was easily controlled. Gastroparesis diabeticorum is one cause of uncontrolled diabetes mellitus and may be helped by the administration of metoclopramide.
Diabetes Care
PMID:Metoclopramide for gastroparesis diabeticorum. 72 49

The gastrointestinal complications of diabetes mellitus are the outward forms of the diabetic visceral neuropathy. The diabetic damage of the vagus nerve leads to disturbances of the tonus and the motility resembling to postvagotomy like conditions in the following clinical forms: diabetic dysphagia, diabetic gastroparesis, diabetic diarrhoea, diabetic megacolon, diabetic cholecystomegaly. These are in general late complications of labile diabetes. The mild abdominal symptoms are not in proportion to the severe radiological changes, proper diagnosis may be obtained only by means of roentgenological examinations in most cases.
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PMID:[Gastrointestinal complications of diabetes mellitus]. 117 96

Diabetic neuropathy in some form or other afflicts a majority of patients with diabetes mellitus. Neuropathic disturbance of sensory, motor or autonomic nerves may occur singly or in combination. Cranial nerve and other mononeuropathies generally resolve spontaneously. Autonomic neuropathy which can result in orthostatic hypotension, gastroparesis diabeticorum, nocturnal diarrhea, atonic bladder and impotence, although chronic, may wax and wane in clinical severity. Neuritis, disesthesias and painful sensory neuritis may resolve with good diabetic control; on occasion, diphenylhydantoin has been of therapeutic benefit.
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PMID:Diabetic neuropathy, A review of clinical manifestations. 124 87

Delayed gastric emptying, gastroparesis, is one of the sequelae of diabetes mellitus. Symptoms may include postprandial nausea, epigastric pain, bloating, vomiting, early satiety and unpredictable blood sugar fluctuations. Nowadays diagnosis is made by the measurement of gastric emptying with a radionuclide test meal. Using this technique some 50% of diabetic patients show signs of disordered gastric emptying. Relief is best delivered by agents promoting gastric emptying. In phase II single-dose studies metoclopramide, domperidone, cisapride, erythromycin and renzapride were all able to enhance gastric evacuation of solid and liquid meals in patients with diabetic gastroparesis. A few short term studies support the efficacy of domperidone and renzapride, but long term trials are lacking. Erythromycin, mimicking the potent gastrokinetic effect of motilin, may hold considerable promise for the future. Experience with erythromycin in diabetic gastroparesis is nonetheless very limited. To some extent the therapeutic effectiveness of metoclopramide and cisapride has been established in placebo-controlled trials. In trials with a placebo-controlled crossover design, however, only metoclopramide showed a sustained positive effect. Metoclopramide, which combines gastrokinetic and antiemetic properties seems, so far, the best therapeutic option in diabetic gastroparesis. Cisapride may be considered as a good alternative in cases where limited efficacy or side effects preclude the use of metoclopramide.
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PMID:Diabetic gastroparesis. A critical reappraisal of new treatment strategies. 128 Oct 70

The long-term complications of diabetes can have a devastating effect on an individual's self-esteem and outlook on life. Some preliminary studies have suggested that normalization of blood glucose levels may prevent or reverse the complications of diabetes in some individuals. Nutrition and diabetes meal planning play a critical role toward achieving this normalization. It is our job as diabetes educators to fully assess a patient's eating and life-style habits, as well as to recognize any complications from diabetes that the patient may be coping with at this time. Depending on the type of complication, diet alterations may need to be made to meet the patient's current needs, ie, reducing fiber content of the diet temporarily in patients with mild gastroparesis, or increasing the protein content of the diet in patients with nephropathy and a foot ulcer. By setting positive, attainable goals, the individual with diabetes may lead a healthier, more productive life in which the complications from diabetes can be prevented, reduced, or better tolerated.
Diabetes Educ
PMID:Nutritional considerations for other complications of diabetes. 129 3

Two patients, a 28-year-old male and a 70-year-old female, with chronic insulin dependent diabetes mellitus and evidence of autonomic neuropathy were studied using cortical evoked responses following esophageal balloon and electrical stimulation. Both patients had symptomatic gastroparesis, poor gastric emptying, and reduced gastroduodenal motility including abnormal results of scintigraphy and manometry. There was slowing of afferent vagal conduction but good evoked potential responses were recorded even though one patient could not feel electrical stimulation of either the proximal or distal esophagus. It is improbable that the gastric symptoms are due to an afferent autonomic neuropathy, but symptoms may well be related to impairment of motor vagal pathways. Nevertheless, afferent vagal pathways are involved in severe diabetes mellitus. The clinical significance of this delay in conduction velocity of afferent pathways remains to be established.
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PMID:Evidence of impaired afferent vagal function in patients with diabetes gastroparesis. 138 75

This work explored the role of the cholinergic pathway, assessed at a post-synaptic level by the use of isolated smooth muscle cells, in the impairment of antral motility associated with diabetic gastroparesis. Contractile response to carbachol--but not to erythromycin, a motilin receptor agonist--was abolished in antral smooth muscle cells isolated from (i) rats previously rendered diabetic by a single i.v. dose of streptozotocin (STZ, 60 mg/kg) and (ii) db/db spontaneously diabetic mice. Insulin treatment of STZ-rats was able to prevent the impairment of the carbachol contractile response, but not to reverse it once established. In STZ-rats, impairment of contractile response was not associated with a change in density of [3H]-N-methyl-scopolamine ([3H]-NMS) binding sites (approximately 1.5 fmol/mg protein). Displacement curve of the [3H]-NMS binding by carbachol was shifted to the right in diabetic rats as compared to controls. The addition of GTP-gamma-S induced a shift to the right of the displacement curve in control but not in diabetic animals. These results strongly suggest that diabetes is associated with an early and specific alteration of the muscarinic control of contraction of antral smooth muscles at a post-synaptic level, associated with an alteration of the GTP-binding proteins coupled to muscarinic receptors.
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PMID:Impairment of contractile response to carbachol and muscarinic receptor coupling in gastric antral smooth muscle cells isolated from diabetic streptozotocin-treated rats and db/db mice. 138 42


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