Delayed Gastric Emptying

Hyperglycaemia delays gastric emptying (62) as do multiple other factors, many of which remain poorly understood. Physiological inhibitory pathways exist that control gastric emptying and involve small intestinal receptors that are stimulated by nutrients in the lumen of the gut. Posture, meal size and meal composition all influence gastric emptying through activating these receptors. Dietary fat empties at a slower rate than protein or carbohydrate and liquids empty faster than solids.

A modest degree of gastroparesis occurs with ageing. However, this is much commoner in people with diabetes; upto half of all patients with long-standing diabetes (both Type 1 and 2) have some evidence of delayed gastric emptying (62). Gastroparesis affects both glycaemic control as well as oral hypo-glycaemic drug absorption, and in elderly people may precipitate post-prandial events, which may lead to loss of consciousness and falls.

Delayed gastric emptying can be asymptomatic, making the diagnosis difficult. Symptoms, if present, include nausea, vomiting and abdominal fullness. However, none of these symptoms correlate well with gastric emptying. Patients presenting with gastrointestinal symptoms, who already have diabetic complications, in particular autonomic neuropathy, are major candidates for this condition or other disorders of gut motility. Hyper-glycaemia may contribute to these symptoms as it has been reported to increase the perception of sensations arising from the gut (63).

Delays in gastric emptying can reduce the rate of drug transit and slow the rate of absorption. A few studies have been conducted in patients with diabetes that demonstrate a correlation between the absorption of glibenclamide and glipizide and gastric emptying time (62). With drugs that have a long half-life and are given long-term, this effect would not be expected to lead to significant alterations in blood concentrations of the drug.

Gastric emptying can affect glycaemic profiles. Rapid gastric emptying can cause glycaemic spikes and a worsening of control. On the other hand, when gastric emptying is delayed a mismatch with the onset of hypoglycaemic drug action and glucose absorption can occur, leading to hypoglycaemia.

Figure 10.1. Taking steps to tackle eating problems

Source-. Reproduced from the British Dietetic Association s Nutrition Advisory Group for Elderly People (64).

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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