[36M] With recurrent vomiting and gastroparesis

Patient Description

A 36-year-old male with a history of type 1 diabetes, diagnosed at age 31, presents with recurrent episodes of nausea, gas, and forceful vomiting. These episodes vary in duration, lasting from a few hours to several days, and occur as frequently as every 20 minutes. Severe episodes lead to dehydration and hospitalization for ketoacidosis. The patient has been diagnosed with gastroparesis but reports that current medication (Metoclopram 5mg twice daily and Pantoprazole 40mg once daily) is ineffective. Episodes typically begin early in the morning. Additional symptoms include daily fatigue, tiredness, and achy muscles rated at 6/10 in severity. The patient also has cysts on the gallbladder and left kidney. No specific food or activity triggers have been identified, and blood sugar levels remain stable before episodes. No other medications, supplements, or allergies reported. No family history of gastrointestinal issues or diabetes complications.

Arora's Assessment

What might be happening

Your symptoms and history suggest a few possible issues:

Gastroparesis: This condition slows down the movement of food from your stomach to your intestines, causing nausea, vomiting, and bloating. It's common in people with diabetes. Treatment often includes dietary changes, medications like Metoclopram, and sometimes procedures to help manage symptoms.
Diabetic Ketoacidosis (DKA): This is a serious complication of diabetes that can occur when your body starts breaking down fats too quickly, leading to high levels of ketones. It can be triggered by episodes of vomiting and dehydration. Managing blood sugar levels and staying hydrated are crucial.
Muscle Pain and Fatigue: These could be related to your diabetes or possibly due to other factors like stress or nutritional deficiencies. Regular monitoring and managing your diabetes can help alleviate these symptoms.

What you can do

Gastroparesis:

Eat smaller, more frequent meals and avoid high-fat and high-fiber foods.
Stay upright for a few hours after eating to help digestion.
Continue taking your prescribed medications and discuss any adjustments with your doctor.

Managing DKA Risk:

Monitor your blood sugar levels closely, especially during episodes.
Stay hydrated by sipping on clear fluids like water or electrolyte solutions.
Seek medical attention if you notice signs of DKA, such as fruity-smelling breath or confusion.

Muscle Pain and Fatigue:

Engage in gentle exercises like walking or stretching to help with muscle pain.
Ensure you're getting enough rest and managing stress.
Discuss with your doctor if you need any supplements or changes in your diabetes management.

Consider using MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

What you should look out for

Severe dehydration: If you can't keep fluids down, seek medical attention to prevent complications.
Signs of DKA: Such as rapid breathing, confusion, or abdominal pain.
Persistent or worsening symptoms: If your current treatment isn't helping, consult your healthcare provider for further evaluation.

Remember, it's important to work closely with your healthcare team to manage these conditions effectively.

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9 mo ago

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