Diabetic Gastroparesis — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesDiabetic GastroparesisRACP Adult Medicine

A 42-year-old woman with type 1 diabetes presents with nausea, vomiting, and early satiety after meals. Her HbA1c is 77 mmol/mol with erratic blood glucose patterns (postprandial spikes followed by delayed hypoglycaemia). Gastric emptying study shows significantly delayed emptying. What is the diagnosis?

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Correct answer: D — Gastroparesis

Diabetic gastroparesis is delayed gastric emptying in the absence of mechanical obstruction, occurring in 20–50% of longstanding type 1 diabetes. It results from vagal nerve autonomic neuropathy. The erratic glucose pattern (postprandial spikes from delayed nutrient absorption then late hypoglycaemia as insulin peaks before food is absorbed) is characteristic. Management includes dietary modification (small, frequent, low-fat, low-fibre meals), prokinetics (metoclopramide – short-term due to tardive dyskinesia risk; domperidone; erythromycin), and glycaemic optimisation.

Reference: eTG – 2025 – Gastrointestinal; ADS – 2024 – Diabetic Complications