NICE - gastroparesis in type 1 diabetes

• a small-particle-size diet (mashed or pureed food) is advised for symptomatic relief for adults with type 1 diabetes who have vomiting caused by gastroparesis
• continuous subcutaneous insulin infusion (CSII or insulin pump) therapy should be considered for adults with type 1 diabetes who have gastroparesis

For adults with type 1 diabetes who have vomiting caused by gastroparesis, explain that:

• there is no strong evidence that any available antiemetic therapy is effective
• some people have had benefit with domperidone, erythromycin or metoclopramide
• the strongest evidence for effectiveness is for domperidone, but prescribers must take into account its safety profile, in particular its cardiac risk and potential interactions with other medicines

For treating vomiting caused by gastroparesis in adults with type 1 diabetes:

• alternating use of erythromycin and metoclopramide should be considered
• use domperidone only in exceptional circumstances (that is, when it is the only effective treatment) and in accordance with MHRA guidance

Refer adults with type 1 diabetes who have gastroparesis for specialist advice if the interventions above are not beneficial or not appropriate

Reference:

• NICE (August 2015). Type 1 diabetes in adults: diagnosis and management