If a blood sugar patient’s phase 1 insulin release is very little, the patient must take newer pancreas-provoking OHAs, or sulfonylurea (one of the older-type) or fast-acting insulin before each meal. After taking this medication, the patient must not skip any of his meals; else the blood sugar level will sharply shoot up.
In the same manner and in case of stomach emptying is too slow; the same effect of skipping a meal will take place. However, pre-indication of stomach emptying can help in either delaying the insulin shot or regularly adding some NPH insulin for slowing down its action.
Unpredictability & gastroparesis
Gastroparesis is always unpredictable. It is difficult to predict about the timing and fastness of stomach emptying for those patients who have gastroparesis problem. In these cases and in the absence of spasm in pyloric valve, emptying of stomach content may be brisk & partial and may get emptied within 3 hours. On the other side, if the valve is tight, the emptying of stomach may be delayed for days, causing the plummeting of blood sugar, just within 1-2 hours of meal. This will be followed by high shoot up of blood sugar level after 12 hours of time period and also after emptying occurs. Because of this unpredictability and also because of the seriousness involved in the insulin or in the cases of OHAs-taking patients, controlling blood sugar becomes impossible, if there is any negligence in taking gastroparesis before meals.
Phase i & phase ii insulin
The blood sugar control of those patients, who have type 2 diabetics, is not that much grossly affected by the symptomatic gastroparesis. The reason is these patients can produce some amount of phase I as well phase II insulin. The advantagious point for these patients is, insulin injections are not that much needed for them for covering their low carbohyderate meals. The main purpose of producing their insulin is responding to the elevation of blood sugar. That is why in case of stomach emptying problem, fasting or low basal insulin levels are released. Due to which there is no issue of the occurrence of hypoglycaemia. Hence, it must be noted that OHAs and sulfonylurea are responsible for causing hypoglycaemia.
Type2 beta cells in blood sugar
In case of very slow, but continuous emptying of stomach, the concurrent production of insulin by most of type2’s beta cells is obvious. In some cases, because of the relaxation of pyloric valve, the stomach may get emptied suddenly. The result will be the rapid rise of blood sugar; the reason being the carbohydrate’s sudden absorption after the small intestinal- entry of stomach contents. Under this circumstance, most of the type2 beta cells cannot counter rapidly the situation. However, as a result of it and by following a reasonable regimen, insulin gets released and thus blood sugar comes down to normal. If a patient empties his supper before sleep, the blood sugar level of the patient will sharply shoot up in the very morning, even though the blood sugar level might have been low or normal at the time of supper
Under any circumstance, if a patient does not get on with sulfonylurea type OHA or require insulin before meal, there will be the least probability of hypoglycaemia related issues that has relation with his stomach emptying. This may be assumed that either of sulfonylurea or long-acting insulin, if administered in doses, will cover the fasting state. If these medications are used for a long period of time for covering fed state and fasting, it may lead to postprandial hypoglycemial hazards due to the presence of gastroparesis.