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Your search term(s) "gastroparesis" returned 56 results.

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Gastroparesis: A Case of Unexplained Lows. Diabetes Forecast. 56(9): 69-72. September 2003.

Gastroparesis is a form of nerve damage that affects the stomach, resulting in a slowed motility (movement) of gastric contents. Gastroparesis develops in 40 to 50 percent of people who have had type 1 diabetes for more than 20 years and in 30 to 40 percent of those with long-standing type 2 diabetes. This article shares the experience of one person with diabetes who developed gastroparesis. Topics include how gastroparesis is diagnosed, a typical symptom questionnaire, blood glucose (sugar) target ranges, adjusting insulin dosage to carbohydrate intake, diet suggestions for people with gastroparesis, suggested insulin regimens, and strategies for patients using insulin pumps. 3 figures.

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Art and Science of Insulin-Pump Therapy. In: Leahy, J.L. and Cefalu, W.T., eds. Insulin Therapy. Monticello, NY: Marcel Dekker, Inc. 2002. p. 223-244.

This chapter on insulin pump therapy is from a reference book that explores the pharmacokinetics of insulin and insulin programs. The book focuses on the latest blood glucose self-monitoring equipment and assessment strategies that can achieve optimal glycemic control and thus reduce the occurrence of complications including retinopathy (eye disease), neuropathy (nerve disease), nephropathy (kidney disease) and cardiovascular disease. In this chapter, the author notes that insulin pumps provide the best method of achieving normal blood sugars, based on multiple studies documenting improved control across all population groups, ages, genders, and socioeconomic backgrounds. The author discusses the research studies, the use of insulin pump therapy in adult patients with type 1 diabetes mellitus, insulin pump therapy in pediatric patients, implementing pump therapy, insulin pump therapy in type 2 diabetes, insulin pump therapy during pregnancy, and special considerations, including hypoglycemic unawareness and the problem of renal disease and neuropathies (nerve diseases) such as gastroparesis. 3 figures. 3 tables. 63 references.

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Delayed Gastric Emptying and Gastric Autoimmunity in Type 1 Diabetes. Diabetes Care. 25(5): 912-917. May 2002.

Delayed gastric (stomach) emptying (gastroparesis) and or other gastrointestinal symptoms occur in 30 to 50 percent of people with diabetes. Known contributing factors for this problem are autonomic neuropathy (nerve disease) and acute hyperglycemia (high blood glucose), but the role of gastric autoimmunity has never been investigated, even though 15 to 20 percent of people with type 1 diabetes exhibit parietal cell antibodies (PCAs). This article reports on a study of gastric motility in diabetes in relation to PCA status, autonomic nerve function, HbA1c (glycosylated hemoglobin a measure of blood glucose over time), thyroid stimulating hormone (TSH), Helicobacter pylori (HP), acid production, and gastric histology. The study included 42 patients with type 1 diabetes: 29 men, 13 women; 15 PCA positive; mean age 40 years plus or minus 15 years; mean HbA1c 7.8 percent plus or minus 0.9 percent. Solid gastric emptying was delayed in 40 percent and liquid emptying in 36 percent of patients. Gastric motility did not correlate with symptoms. PCA status, gastric morphology (shape), and acid secretion were similar in those with and without gastroparesis. HbA1c level was the only risk factor for delayed solid emptying in a logistic regression model. The authors found that approximately 50 percent of the type 1 diabetes patients studied had delayed gastric emptying that did not correlate with symptoms. Gastric autoimmunity did not contribute to diabetic gastroparesis. Metabolic control was worse in patients with delayed solid emptying. 3 tables. 47 references.

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Diabetic Polyneuropathy. In: Veves, A.; Giurini, J.M.; LoGerfo, F.W. Diabetic Foot: Medical and Surgical Management. Totowa, NJ: The Humana Press, Inc. 2002. p.75-98.

Polyneuropathy is one of the most common complications of diabetes and the most common form of neuropathy (nerve disease) in the developed world. Diabetic polyneuropathy encompasses several neuropathic syndromes, the most common of which is distal symmetrical neuropathy, the main initiating factor for foot ulceration. This chapter on diabetic polyneuropathy is from a textbook on the medical and surgical care of foot problems in people with diabetes. The author discusses the classification of polyneuropathy; symmetrical neuropathies, including distal symmetrical neuropathy, and acute painful neuropathies; asymmetrical neuropathies, include proximal motor neuropathy, cranial mononeuropathies, truncal radiculopathy, and pressure palsies (notably carpal tunnel syndrome); the pathogenesis of distal symmetrical neuropathy, including chronic hyperglycemia (high blood glucose levels), oxidative stress, increased polyol pathway flux, nonenzymatic glycation, neurotrophic factors, protein kinase C activation, and vascular factors; autonomic neuropathy, including cardiovascular, gastrointestinal (gastroparesis), abnormal sweating, and abnormalities of bladder function; the management of diabetic neuropathy through glycemic control, tricyclic compounds, anticonvulsants, topical capsaicin, intravenous lignocaine and oral mexiletine, and alpha lipoic acid; and the management of disabling painful neuropathy that is nonresponsive to pharmacological (drug) treatment. 3 figures. 6 tables. 101 references.

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Insulin Lispro Update. Diabetes Educator. 28(2): 269-277. March-April 2002.

This article provides a review of the literature and clinical studies for insulin lispro and updated information on its advantages over regular insulin for various populations of people with diabetes. Information was gathered from a search of Medline articles and from review of clinical studies. Patients in various special populations using insulin lispro, with proper adjustment of basal insulin, had a greater reduction in hemoglobin A1c (glycosylated hemoglobin, a measure of blood glucose over time), and fewer episodes of hypoglycemia than patients on regular insulin. More recently published literature shows that due to its faster onset and shorter duration of action, insulin lispro is useful for not only lowering A1c values, but also for reducing hypoglycemic (low blood glucose) events in various populations with diabetes, including pediatric and pregnant patients, those with gastroparesis, and insulin pump users. 3 figures. 3 tables. 18 references.

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Long-Term Complications. In: Edelman, S.V. and Henry, R.R. Diagnosis and Management of Type 2 Diabetes. Caddo, OK: Professional Communications, Inc. 2002. p. 211-254.

This chapter on the long term complications of type 2 diabetes is from a handbook for primary care providers that offers a concise overview of the diagnosis and management of type 2 diabetes. Patients with type 2 diabetes are prone to long term complications including macrovascular disease; microvascular disease, including diabetic retinopathy (eye disease), diabetic neuropathy (nerve disease), diabetic nephropathy (kidney disease), and diabetic foot disorders. Diabetic neuropathy can encompass complications including gastroparesis (delayed stomach emptying), diabetic diarrhea, neurogenic bladder, impaired cardiovascular reflexes, and sexual dysfunction. The authors describe each of these complications and outline steps (focusing primarily on drug therapies) that can be taken to prevent or treat each problem. They stress that the long term, chronic complications of diabetes have the greatest impact on the health of individuals with diabetes as well as on the health care system. Consequently, early detection and aggressive treatment of these complications are essential to reduce associated morbidity and mortality. 3 figures. 10 tables. 38 references.

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Gastric Motor and Sensory Function, and Motor Disorders of the Stomach. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 691-713.

The main functions of gastric (stomach) motility are to accommodate and store the ingested meal, grind down solid particles, and then empty all of the constituents of the meal in a carefully controlled and regulated fashion into the duodenum. This chapter on gastric motor and sensory function, and motor disorders of the stomach is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics covered include electrophysiologic basic of gastric motor activity, patterns of gastric contractile activity, regulation of gastric emptying and related motor activity, gastric sensation, role of the stomach in the regulation of digestion and food intake, and development of gastric motor activity; assessment of gastric emptying by scintigraphy, alternatives to scintigraphy, ultrasonography, magnetic resonance imaging (MRI), electrical impedance methods, electrogastrography, barostat systems, antroduodenal manometry, gastrointestinal neuropathology, current status of gastric motility testing; symptoms of gastric motor disorders, postsurgical syndromes, diabetic gastroenteropathy, idiopathic gastroparesis, nonulcer dyspepsia, and dysmotility, gastric motor function in acid peptic disease, gastrointestinal motor dysfunction related to viral illness, gastric motor function in autonomic neuropathy, pseudo-obstruction syndromes; and therapeutic considerations, including available compounds, treatment of the patient with established gastroparesis, and motility issues in dyspepsia. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 14 figures. 3 tables. 222 references.

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Long-Term Cisapride Treatment Improves Diabetic Gastroparesis But Not Glycaemic Control. Alimentary Pharmacology and Therapeutics. 16(7):1341-1346. July 2002.

In patients with diabetic gastroparesis (delayed emptying of the stomach's contents), delayed food delivery to the intestine may become a major obstacle to postprandial (after a meal) glycemic control. This article reports on a study undertaken to investigate whether cisapride accelerates gastric (stomach) emptying in the long term or improves diabetes control in patients with diabetic gastroparesis. The study included 85 patients with longstanding insulin dependent diabetes mellitus, dyspepsia, and diabetic neuropathy who were tested for impaired gastric emptying of solids. Nineteen of these patients with severe diabetic gastroparesis were randomly treated with 10 milligrams cisapride three times a day (n = 9) or placebo (n = 10) for 12 months. Thereafter, the breath test, dyspeptic symptoms and glycosylated hemoglobin (a measure of blood glucose control over time) values were reassessed. Half emptying times in nine patients with diabetic gastroparesis were significantly shortened by cisapride. Half emptying times in the 10 patients taking placebo did not change. Cisapride significantly reduced dyspepsia. HbA1c (glycosylated hemoglobin) values after 12 months of treatment were not different. The authors conclude that prokinetic treatment with cisapride accelerates gastric emptying of solids and improves dyspeptic symptoms in diabetic gastroparesis. Glycemic control, however, is not affected by cisapride. 2 figures. 2 tables. 22 references.

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Neuropathy. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.463-496.

Neuropathy (nerve disease) complicates the management of diabetes. This chapter on diabetic neuropathy (nerve disease associated with diabetes) is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. Somatic neuropathy (calluses and warm insensate feet) with loss of reflexes or vibration perception increases susceptibility to ulcers, Charcot joint destruction, and limb loss. Autonomic nerve dysfunction impairs the ability to exercise because of decreased systolic and diastolic cardiac function; postural hypotension (low blood pressure) and nocturnal or supine hypertension (high blood pressure); impaired cutaneous (skin) blood flow and sweating; impaired pupillary reaction and night vision; and gastroparesis (reduced gastrointestinal motility) with irregular fuel delivery. Preferred exercise for this population are non weight-bearing. Rates of perceived exertion is a safer guide for exercise intensity than heart rate. The authors provide a paradigm for exercise in patients with cardiovascular autonomic neuropathy. The authors also note that foot care education reduces the risk of ulcers and gangrene by one-third. 3 figures. 2 tables. 105 references.

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Diabetic Autonomic Neuropathy. Practical Diabetology. 20(2): 48-49. June 2001.

Autonomic neuropathy affects the nerves that regulate involuntary body functions and systems such as the digestive system, the sexual organs, the urinary tract, the heart, and the sweat glands. Symptoms include sexual dysfunction, delayed emptying of the stomach (gastroparesis), diarrhea, and difficulty urinating. This patient education fact sheet describes diabetic autonomic neuropathy (DAN), the reasons to get tested for this condition, diagnostic tests used to confirm DAN, and how to prevent and modify the complications that can occur from DAN. DAN is usually diagnosed using heart rate variability (HRV) testing. This easy, noninvasive test looks at how one of the organs controlled by the nervous system (the heart) responds to simple exercises. Three exercises are performed: breathing deeply for one minute, blowing with force (as if filling a balloon) for 15 seconds, and standing up from a lying down position. Each exercise should normally cause one's heart rate to change. By carefully measuring how much the heart rate changes, along with other factors, a physician can diagnose DAN. Keeping one's diabetes well controlled is the best preventive strategy. Physicians can treat DAN aggressively through medicines, treatments, or simply by helping the patient to gain better control of their blood glucose (sugar) levels. One figure illustrates the different body systems that can be affected by diabetic autonomic neuropathy. 1 figure.

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