Role and Efficacy of Chronic Intermittent Intravenous Insulin Infusion Therapy in Patients with Diabetic Gastroparesis

Diabetic gastroparesis is characterised by a delay in gastric emptying after a meal in the absence of a mechanical gastric outlet obstruction. Chronic intermittent intravenous insulin therapy (CIIIT) involves delivering insulin intravenously in an infusion over a 6-12 hour period in a pulsatile fashion adjusting the dosages based on frequent blood sugar monitoring. The aim of the study was to evaluate the efficacy of CIIIT in patients of diabetic gastroparesis. Fifty euglycemic cases of diabetes mellitus having signs and/or symptoms of diabetic gastroparesis not relieved with conventional pharmacotherapy were considered for the study. CIIIT was given and the symptoms were compared at the commencement of the study, after 6 sessions of CIIIT (i.e. after 3 months) and finally after 6 months by asking the patient to grade their symptoms on the Visual Analogue Scale (VAS) on each visit. At the conclusion of our study, we found that patients who were previously refractory to conventional pharmacotherapy, showed considerable response to CIIIT with most patients giving history of improvement in their symptoms after therapy and during follow up. The VAS scores showed significant decline in all symptoms and HbA1c levels also remained in the euglycemic range throughout. Therefore, it is recommended that patients presenting with complaints of diabetic gastroparesis should be managed by CIIIT rather than the conventional pharmacological therapies.