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Insulin in Gastroparesis — RACP Adult Medicine MCQ

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HardEndocrinology & DiabetesInsulin in GastroparesisRACP Adult Medicine

A 42-year-old man with type 1 diabetes on basal-bolus insulin develops gastroparesis. His postprandial glucose control is erratic with frequent hypoglycaemia 3–4 hours after meals. What insulin delivery strategy best addresses gastroparesis-related glucose variability?

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Correct answer: D — Split bolus insulin dosing (give portion before meal, remainder 1–2 hours later)

Gastroparesis causes unpredictable gastric emptying, leading to glucose-insulin mismatch (insulin peaks before nutrients are absorbed). Split-bolus dosing (giving 50–70% of the bolus before the meal and the remainder 1–2 hours later, or using extended/dual-wave bolus on an insulin pump) better matches insulin delivery to delayed nutrient absorption. Insulin pumps with extended bolus features are particularly useful. Continuous glucose monitoring helps detect and manage glucose excursions. Prokinetics (metoclopramide, domperidone, erythromycin) may also improve emptying.

Reference: ADS – 2024 – Type 1 Diabetes in Complex Situations; eTG – 2025 – Endocrinology