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Gastroparesis affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes. Typical symptoms are nausea, vomiting, early satiety, bloating, and postprandial fullness.

C. Screening for vitamin and mineral deficiencies

Answer: A. Optimization of glucose levels

Very high levels of blood glucose (ie, >200 mg/dL) can lead to delayed gastric emptying, therefore optimizing glucose levels is the first step in management of diabetic gastroparesis. 

Diabetic neuropathy related to chronic elevation of blood glucose can impair function anywhere in the nervous system. In the gastrointestinal tract, it essentially causes an autovagotomy. Hyperglycemia also may cause anatomic disruption at the cellular level throughout the GI tract ultimately causing reduced motility in the antrum and proximal stomach. Pylorospasm is also seen.

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Symptoms of diabetic gastroparesis include nausea, vomiting, early satiety, and bloating. Where should management start?

First-line Treatment for "Diabetic Stomach"