Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet

Diabetes mellitus (DM) has wider neurological complications. They include upper gastrointestinal (GI) symptoms, impaired motility, impaired gastric emptying (GE) and diabetic gastroparesis (DG), which are usually found. The patient was a 64-year-old man with type 2 diabetes (T2D) for 22-years. The patient weighed 74 kg with body mass index (BMI) 23.6 kg/m2, hemoglobin A1C (HbA1c) 9.2%, ankle brachial index (ABI) 1.19/1.23, AST 25 U/L(7-38), ALT 23 U/L(4-44), GGT 48 U/L(<86), Chest X-P normal, and electrocardiogram (ECG) negative. When the patient was treated with low carbohydrate diet (LCD), a significant reduction in body weight and HbA1c was observed. Abdominal computerized tomography (CT) revealed multiple gall stone, dilated common bile duct and impaired GE, indicating DG. For endoscopic examination, much food residue was found in the stomach due to DG after 13 hours fasting. Treatment for DG was initiated by mosapride citrate hydrate. During clinical progress, occasional liver dysfunction was observed twice associated with elevation of AST 196 U/L, GGT 373 U/L and without symptoms, indicating cholestasis-type dysfunction. Some possible triggers may be involved in these episodes, such as gall stone, enlarged volume of stomach due to DG, overeating, overdrinking, and other factors. This impressive report will hopefully become a reference for developing diabetic practice and research.