Hypoglycemia Accelerates Gastric Emptying in Diabetics

Acute insulin-induced hypoglycemia accelerates gastric emptying of solids and liquids in patients with long-standing type 1 diabetes. The phenomenon represents “an important counter-regulatory mechanism to hypoglycemia.

It is now recognized that the rate of gastric emptying of a carbohydrate-containing meal is a major determinant of postprandial glycemia, Dr. Antonietta Russo and colleagues from the University of Adelaide in South Australia point out. In 30% to 50% of patients with long-standing diabetes, gastric emptying is abnormally slow.

Data are lacking, however, on the effects of acute hypoglycemia on gastric emptying in diabetics or whether the response to hypoglycemia is influenced by the rate of gastric emptying during euglycemia or the presence of autonomic dysfunction.

Using scintigraphy, Dr. Russo’s team analyzed gastric emptying of a solid/liquid test meal during hypoglycemia and euglycemia in a heterogeneous group of 20 patients with long-standing type 1 diabetes. Five had delayed solid emptying, seven had delayed liquid emptying during euglycemia, and 12 had autonomic neuropathy.

The researchers observed that gastric emptying of both solids and liquids was faster during hypoglycemia compared with euglycemia.

Moreover, the magnitude of the acceleration in gastric emptying was greater in patients who had slower gastric emptying during euglycemia.

"Hence, there is no evidence to suggest that the response to hypoglycemia may be impaired by gastroparesis; rather, as has been shown to be the case with many gastrokinetic drugs, the response is in general more marked when gastric emptying is delayed," the authors note.

Autonomic nerve function did not appear to have an impact on the rate of gastric emptying in this study.

J Clin Endocrinol Metab 2005;90:4489-4495.

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