Advertisement

Diabetologia

, Volume 33, Issue 11, pp 675–680 | Cite as

Hyperglycaemia slows gastric emptying in Type 1 (insulin-dependent) diabetes mellitus

  • R. J. Fraser
  • M. Horowitz
  • A. F. Maddox
  • P. E. Harding
  • B. E. Chatterton
  • J. Dent
Originals

Summary

In 10 patients with Type 1 (insulin-dependent) diabetes mellitus gastric emptying of a digestible solid and liquid meal was measured during euglycaemia (blood glucose concentration 4–8 mmol/l) and during hyperglycaemia (blood glucose concentration 16–20 mmol/l). Gastric emptying was studied with a scintigraphic technique and blood glucose concentrations were stabilised using a modified glucose clamp. Patients were also evaluated for gastrointestinal symptoms, autonomic nerve function and glycaemic control. When compared to euglycaemia, the duration of the lag phase before any of the solid meal emptied from the stomach (p = 0.032), the percentage of the solid meal remaining in the stomach at 100 min (p = 0.032) and the 50% emptying time for the solid meal (p = 0.032) increased during hyperglycaemia. The 50% emptying time for the liquid meal (p = 0.042) was also prolonged during the period of hyperglycaemia. These results demonstrate that the rate of gastric emptying in Type 1 diabetes is affected by the blood glucose concentration.

Key words

Gastric emptying stomach hyperglycaemia autonomic neuropathy 

References

  1. 1.
    Horowitz M, Harding PE, Maddox A, Maddern GJ, Collins PJ, Chatterton BE, Wishart J, Shearman DJC (1986) Gastric and oesophageal emptying in insulin-dependent diabetes mellitus. J Gastroent Hepatol 1: 97–113Google Scholar
  2. 2.
    Keshavarzian A, Iber FL, Vaeth J (1987) Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroent 82: 29–35PubMedGoogle Scholar
  3. 3.
    Horowitz M, Harding PE, Maddox A, Wishart JM, Akkermans LMA, Chatterton BE, Shearman DJC (1989) Gastric and oesophageal emptying in patients with Type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 32: 151–159CrossRefPubMedGoogle Scholar
  4. 4.
    Kassander P (1958) Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 48: 797–812PubMedGoogle Scholar
  5. 5.
    Feldman M, Schiller LR (1983) Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 98: 378–384PubMedGoogle Scholar
  6. 6.
    Camilleri M, Malagelada J-R (1984) Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Invest 14: 420–427PubMedGoogle Scholar
  7. 7.
    Malagelada J-R, Rees WDW, Mazzotta LJ, Go VLW (1980) Gastric motor abnormalities in diabetic and postvagotomy gastroparesis, effect of metoclopramide and bethanechol. Gastroenterology 78: 286–293PubMedGoogle Scholar
  8. 8.
    MacGregor IL, Gueller R, Watts HD, Meyer JH (1976) The effect of acute hyperglycaemia on gastric emptying in man. Gastroenterology 70: 190–196PubMedGoogle Scholar
  9. 9.
    Aylett P (1962) Gastric emptying and change of blood glucose level as affected by glucagon and insulin. Clin Sci 22: 171–178PubMedGoogle Scholar
  10. 10.
    Morgan LM, Tredger JA, Hampton SM, French AP, Peake JC, Marks V (1988) The effect of dietary modification and hyperglycaemia on gastric emptying and gastric inhibitory polypeptide (GIP) secretion. Br J Nutr 60: 29–37PubMedGoogle Scholar
  11. 11.
    De Fronzo RA, Tobin JD, Andres R (1978) Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 237: E214–223Google Scholar
  12. 12.
    Horowitz M, Harding PE, Chatterton BE, Collins PJ, Shearman DJC (1985) Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci 30: 1–9PubMedGoogle Scholar
  13. 13.
    Horowitz M, Maddox A, Harding PE, Maddern GJ, Chatterton BE, Wishart J, Shearman DJC (1987) Effect of cisapride on gastric and esophageal emptying in insulin-dependent diabetes mellitus. Gastroenterology 92: 1899–1907PubMedGoogle Scholar
  14. 14.
    Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285: 916–918Google Scholar
  15. 15.
    Jeppsson J, Jerntorp P, Sundkvist G, Englund H, Nylund V (1986) Measurement of hemoglobin Alc by anew liquid-chromatographic assay. Methodology, clinical utility and relation to glucose tolerance evaluated. Clin Chem 32: 1867–1872PubMedGoogle Scholar
  16. 16.
    Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJC (1983) Gastric emptying in normal subjects. A reproducible technique using a single scintillation camera and computer system. Gut 24: 1117–1125PubMedGoogle Scholar
  17. 17.
    Collins PJ, Horowitz M, Chatterton BE (1988) Proximal, distal and total stomach emptying of a digestible solid meal in normal subjects. Br J Radiol 61: 12–18PubMedGoogle Scholar
  18. 18.
    Soler NG (1980) Diabetic gastroparesis without autonomic neuropathy. Diabetes Care 3: 200–201PubMedGoogle Scholar
  19. 19.
    Wright RA, Clemente R, Wathen R (1985) Diabetic gastroparesis: an abnormality of gastric emptying of solids. Am J Med Sci 289: 240–242PubMedGoogle Scholar
  20. 20.
    Leatherdale BA, Green DJ, Harding LK, Griffin D, Bailey CJ (1982) Guar and gastric emptying in non-insulin dependent diabetes. Acta Diabet Lat 19: 339–343Google Scholar
  21. 21.
    Campbell JW, Heading RC, Tothill P, Buist TAS, Ewing DJ, Clarke BF (1977) Gastric emptying in diabetic autonomic neuropathy. Gut 18: 462–467PubMedGoogle Scholar
  22. 22.
    Loo FD, Palmer DW, Soergel KH, Kalbfleisch JH, Wood CM (1984) Gastric emptying in patients with diabetes mellitus. Gastroenterology 86: 485–494PubMedGoogle Scholar
  23. 23.
    Houghton LA, Read NW, Heddle R, Horowitz M, Collins PJ, Chatterton B, Dent J (1988) The relationship of the motor activity of the antrum, pylorus and duodenum to gastric emptying of a solid-liquid mixed meal. Gastroenterology 94: 1285–1291PubMedGoogle Scholar
  24. 24.
    Meyer JH (1987) Motility of the stomach and gastroduodenal junction. In: Johnson LR (ed) Physiology of the gastrointestinal tract, 2nd edn, vol 1. Raven, New York, pp 613–630Google Scholar
  25. 25.
    Barnett JL, Owyang C (1988) Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology 94: 739–744PubMedGoogle Scholar
  26. 26.
    Fraser R, Horowitz M, Graham S, Dent J (1989) Acute hyper-glycaemia and antropyloroduodenal motility in humans. Gastroenterology 96: A157 (Abstract)Google Scholar
  27. 27.
    Fox S, Behar J (1980) Pathogenesis of diabetic gastroparesis — a pharmacologic study. Gastroenterology 78: 757–763PubMedGoogle Scholar
  28. 28.
    Oliviera RB, Troncon LEA, Meneghelli UG, Dantas RO, Godoy RA (1984) Gastric accommodation to distention and early gastric emptying in diabetes with neuropathy. Braz J Med Biol Res 17: 49–55PubMedGoogle Scholar
  29. 29.
    Feldman M, Smith HJ, Simon TR (1984) Gastric emptying of solid radiopaque markers: studies in healthy subjects and diabetic patients. Gastroenterology 87: 895–902PubMedGoogle Scholar
  30. 30.
    Hirano T, Niijima A (1980) Effects of 2-deoxy-d-glucose, glucose and insulin on efferent activity in gastric vagues nerve. Experientia 36: 1197–1205PubMedGoogle Scholar
  31. 31.
    Pfeifer MA, Weinberg CR, Cook DL, Reenan A, Halter JB, Ensinck JW, Porte D (1984) Autonomic neural function in recently diagnosed diabetic subjects. Diabetes Care 7: 447–453PubMedGoogle Scholar
  32. 32.
    Hilsted J (1982) Pathophysiology in diabetic autonomic neuropathy: cardiovascular, hormonal, and metabolic studies. Diabetes 31: 730–737PubMedGoogle Scholar
  33. 33.
    Phaosawasdi K, Goppold R, Fisher RS (1981) Pyloric pressure response to insulin-induced hypoglycaemia in humans. Am J Physiol 241: G321–327PubMedGoogle Scholar
  34. 34.
    Schade RR, Dugas MC, Lhotsky DM, Gavaler JS, Van Thiel DH van (1985) Effect of metoclopramide on gastric liquid emptying in patients with diabetic gastroparesis. Dig Dis Sci 30: 10–15PubMedGoogle Scholar
  35. 35.
    Groop LC, Luzi L, DeFronzo R, Melander A (1989) Hyperglycaemia and absorption of sulphonylurea drugs. Lancet II: 129–130CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • R. J. Fraser
    • 1
  • M. Horowitz
    • 1
  • A. F. Maddox
    • 1
  • P. E. Harding
    • 3
  • B. E. Chatterton
    • 4
  • J. Dent
    • 2
  1. 1.Department of MedicineRoyal Adelaide HospitalAdelaideAustralia
  2. 2.Department of GastroenterologyRoyal Adelaide HospitalAdelaideAustralia
  3. 3.Department of EndocrinologyRoyal Adelaide HospitalAdelaideAustralia
  4. 4.Department of Nuclear MedicineRoyal Adelaide HospitalAdelaideAustralia

Personalised recommendations