Table 10.

Summary of nutritional interventions for diabetic gastroparesis

Republished and modified with permission of Dove Medical Press [89]. Permission conveyed through Copyright Clearance Center, Inc.

Hydration: if all else fails, go for liquids	On days when symptoms are worse, try taking just liquids to maintain hydration and to rest the stomach
Meal volume/portion size: multiply frequency and divide the portions	Eat smaller, more frequent meals
Meal consistency: If you can not chew, blenderize	Chew the food thoroughly and take 20–30 min to finish the meal Try solid meals in the morning, switch to semi-liquid and liquid meals over the course of the day Any food can be blended with water, vegetable juice or broth to make a puree When symptoms worse, prefer liquid vs solid meals
Glycemic control: match meals with medicines	Modify meal timing, form of carbohydrate (simple, complex) according to the diabetes treatment regimen and vice versa
Fat: less is more	Fat in liquid is well-tolerated; maintain an intake of 20–30% of calories from fat
Fiber: watch for fur balls	Identify the high-fiber foods that worsen upper GI symptoms, and individualize the sources of fiber Delaying GI transit may modulate the biome and alleviate the symptoms If bezoar formation is a concern, avoid foods causing bezoar, such as fruits with peelings, berries, coconut, legumes and fiber supplements Treat bacterial overgrowth if suspected/symptomatic
Address micronutrient deficiency: bones and blood	Eat nutritious foods first before filling up on “empty calories” Replace iron, B12, vitamin D and calcium deficiency
Weight/body mass index: keep moving	Check body weight twice a week, if the weight is decreasing, increase the amount of liquid supplements. Lose weight if you are overweight Physical activity may improve gastric emptying [90] (Consult your medical team)
Miscellaneous: do not miss the bottom line	Avoid foods that lower esophageal sphincter pressure: pepper-mint, chocolate, fat, and caffeine Avoid caffeine, alcohol, tobacco and stress Avoid chewing gum, which increases air swallowing High-fiber foods should be avoided as they may be more difficult on the stomach and may cause bezoar formation Chew well and eat slowly (30 min meals) Do not lie down immediately after eating. Consult dental/oral health team to improve oral hygiene