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

Erythromycin mimics the effect of the gastrointestinal polypeptide motilin on gastrointestinal motility, probably by binding to motilin receptors and acting as a motilin agonist. Erythromycin may thus have clinical application in patients with disturbances of gastroduodenal motility, such as diabetic gastroparesis. To examine this possibility, we studied the effect of erythromycin on gastric emptying in 10 patients with insulin-dependent diabetes mellitus and gastroparesis. We studied the emptying of liquids and solids simultaneously on separate days after the intravenous administration of erythromycin (200 mg) or placebo, using a double-isotope technique and a double-blind, crossover design. Erythromycin shortened the prolonged gastric-emptying times for both liquids and solids to normal. For example, 120 minutes after the ingestion of a solid meal, mean (+/- SE) retention was 63 +/- 9 percent with placebo and 4 +/- 1 percent with erythromycin, as compared with 9 +/- 3 percent in 10 healthy subjects. The corresponding values 120 minutes after the ingestion of a liquid meal were 32 +/- 4, 9 +/- 3, and 4 +/- 1 percent, respectively. Gastric emptying also improved, but to a lesser degree, in the 10 patients after four weeks of treatment with oral erythromycin (250 mg three times a day). These preliminary results suggest that erythromycin may have therapeutic value in patients with severe diabetic gastroparesis.
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PMID:Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. 232 69

Diabetes mellitus produces serious complications in several major organ systems. The pulmonary complications, although uncommon and not well recognized, may be life-threatening. We describe a 20-year-old patient with diabetic ketoacidosis in whom pulmonary zygomycosis developed. This condition was complicated by stenosis of the left upper lobe bronchus despite successful treatment of the zygomycosis. Bronchial obstruction has become a well-recognized complication of pulmonary zygomycosis. In addition to infections caused by Zygomycetes, mycobacteria, viruses, and bacteria, the pulmonary complications described in patients with diabetes include pulmonary edema, disordered breathing during sleep, and reductions in elastic recoil of the lungs, diffusing capacity of the lungs for carbon monoxide, and bronchomotor tone. Other reported complications are respiratory alkalosis, cardiorespiratory arrest, pneumothorax, pneumomediastinum, plugging of the airways with mucus, and aspiration pneumonia attributable to diabetic gastroparesis.
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PMID:Pulmonary complications in diabetes mellitus. 250 1

Gastrointestinal disorders associated with diabetes mellitus have a prevalence rate of 30 to 75%. The most prominent disorders are gastroparesis, diarrhea, and constipation. Severity of symptoms range from mild to severe with the most affected patients being at risk for the development of protein calorie malnutrition. An historical review of the major studies which defined the diagnosis, pathophysiology, and prevalence of these disorders is presented. Guidelines for accurate nutritional assessment, which is essential to the decision to initiate nutritional therapy in this difficult to assess population, are also included. Current methods devised for treatment of diabetic gastroparesis and related disorders are presented. Emphasis is placed on recent developments in nutritional support techniques which make it possible to meet the energy requirements of all such patients. Practical outlines for glucose control in patients receiving TPN or enteral feeding and guidelines for transitioning from parenteral feeding to an oral diet are also presented.
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PMID:Overview of gastrointestinal disorders due to diabetes mellitus: emphasis on nutritional support. 264 46

During the course of viral infections, acute delays in gastric emptying are common. Usually, dietary measures suffice, but treatment with dopamine antagonists with their additional antiemetic effect, may be beneficial. The major causes of chronic delayed emptying are diabetes mellitus with autonomic neuropathy, connective tissue diseases such as systemic sclerosis, and gastroparesis following gastric surgery. Diet alone is rarely effective, and prokinetic drugs should be prescribed. The new compound cisapride seems to be particularly effective. Abnormally rapid emptying occurs exclusively following surgical destruction of the gastric outlet and may lead to the dumping syndrome. In general this can be adequately controlled by dietary measures.
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PMID:[Disorders of stomach emptying]. 265 Dec 52

Insulin treatment in 34 type I diabetics (17 women and 17 men; mean age 30.6 [13-72] years) was changed from a conventional to an intensified conventional treatment schedule (ICIT). However, optimal metabolic control was possible in the long term in only 16 patients. A "dawn phenomenon" occurred in 18 patients, compliance was unsatisfactory in five despite intensive instruction, in three the basal insulin requirements could not be determined on an out-patient basis, and two developed marked gastroparesis. Ultratard, used at first as a retard-insulin, proved inadequate in eight patients. In the 16 patients in whom it was possible to continue ICIT, the HbA1c value decreased after 18.0 +/- 7.2 months from 8.4 +/- 1.4% to 7.1 +/- 1.1% (P less than 0.01), fasting blood sugar levels fell from 185.6 +/- 118 mg/dl to 123.2 +/- 11.8 mg/dl. Thus ICIT may significantly contribute to improving the metabolic state of type I diabetics. But factors which may interfere with a satisfactory control of the diabetes must first be excluded. In particular, if the "dawn phenomenon" occurs, other forms of treatment should be attempted.
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PMID:[Intensified conventional insulin therapy. The long-term successes and reasons for failure of this therapeutic concept]. 265 86

Because there is evidence for vagal autonomic neuropathy as the cause of diabetic gastroparesis, we hypothesized that this disorder should be associated with morphologic abnormalities of the abdominal vagus nerve or gastric myenteric plexus, or both. We studied the smooth muscle and myenteric plexus of the stomach in 18 nondiabetic controls and 16 patients with long-standing diabetes. Five of the diabetics had gastroparesis and 11 did not. We utilized conventional histology and Smith's silver technique for visualizing the myenteric plexus. Neurons within the myenteric plexus were quantified in sections stained with each technique. The abdominal vagus nerves from 5 diabetics (2 with gastroparesis) and 12 nondiabetic controls were stained with hematoxylin and eosin, Gomori trichrome, luxol-fast blue, and Holmes' silver stains. There were no abnormalities in the numbers or appearance of neurons or axons in the myenteric plexus of the stomach of diabetics, with or without gastroparesis. Also absent were abnormalities of the smooth muscle or vagus nerve. Thus, no morphologic abnormalities of the gastric wall or abdominal vagus were identified in diabetic gastroparesis.
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PMID:There are no morphologic abnormalities of the gastric wall or abdominal vagus in patients with diabetic gastroparesis. 334 91

"Stomach cockade" can be readily imaged sonographically, so that it has also been possible to carry out studies of gastric motility or measurements of gastric emptying times of fluids. However, the results of measurements should be verified by reference methods using new investigation techniques. For this reason, we measured synchronously by sonography and scintigraphy the emptying of test fluids from the stomach in patients with diabetes mellitus and suspected gastroparesis. We found a correlation of the two methods of measurement, so that sonographic measurement can be regarded as confirmed by scintigraphy as a reference method.
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PMID:[Study of the correlation of sonographic and scintigraphic results in measuring stomach emptying]. 354 36

Metoclopramide hydrochloride is an antiemetic and gastric motility stimulant with a wide variety of extrapyramidal side effects, including parkinsonism. We describe two patients with end-stage renal disease secondary to diabetes mellitus treated with hemodialysis who developed extrapyramidal symptoms during treatment with metoclopramide. One patient with preexisting, well-controlled Parkinson's disease developed increasing rigidity and bradykinesia that became completely refractory to treatment with L-dopa and bromocriptine while taking metoclopramide for diabetic gastroparesis. A second patient with no history of Parkinson's disease developed a resting tremor and facial dyskinesia during treatment with metoclopramide. In both cases, discontinuation of metoclopramide therapy led to prompt improvement of symptoms.
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PMID:Metoclopramide-induced parkinsonism in hemodialysis patients. Report of two cases. 376 55

Gastroparesis diabeticorum is a common complication that develops in patients with diabetes mellitus. Although the pathogenesis remains unclear, the clinical symptoms of nausea, vomiting, and gastric dilatation frequently respond to metoclopramide hydrochloride, an agent that stimulates gastric emptying in addition to acting centrally as an antiemetic. Occasionally, patients are encountered whose severe gastroparesis is unresponsive to oral metoclopramide and who require intravenous therapy or drainage procedures (eg, pyloroplasty or gastrojejunostomy). Rectal administration of metoclopramide successfully controlled the clinical symptoms of gastroparesis diabeticorum in an outpatient after failure of oral dosing, thus avoiding the need for intravenous therapy. Gastric emptying studies and serum metoclopramide levels following a 25-mg rectal dose of metoclopramide hydrochloride verified the efficacy of therapy.
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PMID:Metoclopramide suppositories in the treatment of diabetic gastroparesis. 377 59

Gastric emptying of technetium labeled liquid and solid meals were studied in a group of long-standing, insulin-requiring male diabetics to evaluate the relationship of gastroparesis to symptoms, diabetic control, and diabetic complications. Control subjects and three groups of diabetics were studied: A) no neuropathy; B) peripheral neuropathy; and C) peripheral and autonomic neuropathy. Nine diabetics had gastrointestinal symptoms. Gastric t1/2 liquid emptying was similar in all groups and in controls, but liquid gastric emptying in the first 15 min was significantly more rapid in the diabetics than controls. Solid emptying was prolonged in group C patients. There was a significant correlation between t1/2 solid emptying and the severity of neuropathy. The eight patients with slow solid emptying had more neuropathy and gastrointestinal symptoms than the remaining 22 patients. The type and duration of diabetes, diabetic control, and frequency of retinopathy are independent of gastroparesis. These data indicate that delayed emptying of solids is common (27%) in patients with clinically detectable neuropathy and may often be asymptomatic. Visceral autonomic neuropathy seems the most important underlying factor in diabetic gastroparesis.
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PMID:Gastric emptying in patients with insulin-requiring diabetes mellitus. 379 78


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