Gastroparesis Case

Gastroparesis Case

Meet Maria

Maria, 52 yO, feels nauseated after meals

Next

After clicking on all of the links, go to the next page and answer the questions to help Maria.

Next

Maria's Food Log

CLick to open

Back to clinic

Maria's Glucose Log

Click here

Back to clinic

💡 Teaching Point

Early satiety means the patient feels full after eating only a small amount. In gastroparesis, delayed gastric emptying causes food to remain in the stomach longer, stretching it and signaling fullness prematurely. Because the patient eats less at each meal, they consume fewer calories and nutrients, which can lead to:

• Calorie deficiency

• Weight loss

• Micronutrient and vitamin deficiencies

• Low serum albumin

💊 “Early satiety often leads to weight loss and micronutrient deficiency—monitor nutrition closely.”

Next

Maria's Symptoms

Click on the bubbles to learn about her symptoms

Early satiety

Nausea

Postprandial fullness

Vomiting

Upperabdominal discomfort

Abdominal bloating

Next Page

💡 Teaching Point

In a patient like Maria (with suspected gastroparesis) whose stomach empties slowly, the timing of carbohydrate absorption and insulin action can become mismatched.

• This dys‐synchrony can lead to erratic blood glucose levels even when the insulin dose is consistent. Because the stomach empties slowly, carbs may arrive in the intestine later than expected → insulin given at-mealtime acts too early → may cause relative insulin excess before absorption → risk of hypoglycemia if the insulin peaks and carbs have not yet entered the system.

• Later, when the delayed meal finally empties and is absorbed, there may be a post-absorptive glucose spike, because insulin action is waning or mismatched to the delayed intake.

• The overall effect of delayed emptying is greater variability in glucose levels long-term.

• In addition, slow gastric emptying is strongly linked to poorer glycemic control (higher HbA1c) in diabetic patients with gastroparesis.

Next

💡 Teaching Point

In patients with gastroparesis, food absorption is delayed and unpredictable, so giving insulin before a meal (as in typical diabetes management) can cause insulin to peak before glucose enters the bloodstream. This mismatch increases the risk of early hypoglycemia, followed later by hyperglycemia once the delayed carbohydrates are absorbed. Pharmacist takeaway: For patients with gastroparesis, insulin timing should be individualized—often given after meals or in divided doses—to better align insulin action with delayed glucose absorption.

Next

Assess Maria's Medications

Non-Pharmacologic Plan for Maria

Plan Review

Next

Maria returns to the clinic 3 months later. Her HgbA1c is down to 6.9% and she reports that she has not had any symptoms of nausea or early satiety. She has implemented all of your recommendations and is feeling better! She is grateful for your time spent counseling her on dietary and medication changes. Great job!

Back to Home

Maria's Medication List

Medications: Insulin glargine 35 units every morning insulin lispro 2-8 units before meals prn BG Metformin 1000mg twice daily Glipizide 5mg daily Lisinopril 20mg daily Amlodipine 10mg daily Atorvastatin 20mg at bedtime Amitriptyline 125mg at bedtime Hydrocodone/APAP 5/325mg every 6hours prn pain

Next

“Maria says, ‘I’ve been feeling full after just a few bites and sometimes vomit my food hours later.’ Maria, a 52-year-old woman with type 2 diabetes, has been experiencing nausea, bloating, and a feeling of fullness after just a few bites. She reports she’s been “too full to finish meals” and has unintentionally lost 8 pounds over the past two months.