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[Severe neuropathy in a young diabetic]

N Weintraub1, S Plaut, N Shalev

  • 1Young Adult Diabetic Unit, Beilinson Medical Center, Petah Tikva.

Harefuah
|November 1, 1994
PubMed
Summary

Severe gastroparesis in a young woman with insulin-dependent diabetes mellitus (IDDM) caused recurrent diabetic ketoacidosis (DKA). Prompt diagnosis and treatment with prokinetics and tight glycemic control resolved symptoms and improved her health.

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Area of Science:

  • Endocrinology
  • Neurology
  • Gastroenterology

Background:

  • Insulin-dependent diabetes mellitus (IDDM) can lead to serious complications, including autonomic neuropathy affecting gastric motility.
  • Gastroparesis, a common complication, can manifest as recurrent diabetic ketoacidosis (DKA) and significant weight loss, even in young patients with short disease duration.

Observation:

  • A 19-year-old woman with a 3.5-year history of IDDM presented with 6 months of recurrent DKA, dizziness, and substantial weight loss.
  • Physical examination revealed severe peripheral and autonomic neuropathy. Gastric emptying tests showed delayed emptying (>90% retention at 60 min), and cardiovascular autonomic testing indicated both parasympathetic and sympathetic damage.
  • Notably, the patient had no signs of nephropathy or retinopathy.

Findings:

  • The patient's recurrent DKA and weight loss were attributed to gastroparesis.
  • A treatment regimen involving optimized diabetic control (4 insulin injections, 2 u/kg/day) and high-dose cisapride successfully terminated vomiting.
  • Within 5 months, the patient regained her lost weight, demonstrating significant clinical and functional improvement.

Implications:

  • This case highlights that severe diabetic neuropathy, specifically gastroparesis, can occur early in IDDM and precipitate recurrent DKA.
  • Accurate diagnosis of gastroparesis and targeted prokinetic therapy, alongside near-normoglycemic control, are crucial for managing such cases.
  • Early intervention can lead to dramatic improvements in patients with IDDM-related gastroparesis, preventing severe metabolic derangements.

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