第1型糖尿病合併胃輕癱之營養照護個案報告

糖尿病合併胃輕癱會影響血糖控制及營養狀況，胃腸症狀如腹脹、易飽、噁心及嘔吐等，會導致營養不良和或血糖控制不佳，包括餐後低血糖。在患有糖尿病胃輕癱病人，血糖控制是很重要的，因為高血糖本身抑制胃排空，可能進一步惡化血糖控制；外源性胰島素作用與醣類攝取的搭配，若搭配不佳，可能導致血糖更不穩定。此個案為第1型糖尿病合併胃輕癱，33歲女性，糖化血色素10.3%，血糖控制不佳，有嚴重的胃輕癱症狀，因此減少進食量且體重減輕。營養診斷：個案主要問題為腸胃道功能異常及食物與營養相關知識不足（problem, P）。病因為糖尿病罹病期長且血糖控制不佳導致糖尿病胃輕癱及未曾接受過進階醣類計算的指導。症狀為噁心、嘔吐，減少進食量，胃排空變慢（胃排空測試時間為198分鐘，正常值為66±32分鐘）及應用進階醣類計算能力不足。經進階醣類計算，用胰島素對醣比值（insulin to carbohydrate ratio）為7 和胰島素敏感因子（insulin sensitivity factor）為65，來調整胰島素劑量，改善血糖控制，指導胃輕癱飲食衛教以緩解腸胃不適。病人的糖化血色素從10.3%降至7.6%及體重從44.3 kg增加至52 kg，血糖及體重均得到改善。糖尿病胃輕癱病人的管理包括改善胃排空、緩解胃腸道症狀及改善血糖控制與營養狀態。

關鍵字

第1型糖尿病；胃輕癱；糖化血色素；營養照顧

並列摘要

Diabetic gastroparesis can affect blood sugar control and nutritional status, manifesting as gastrointestinal (GI) symptoms such as abdominal bloating, early satiety, nausea, and vomiting resulting in poor blood sugar control (i.e., postprandial hypoglycemia) and malnutrition. The goal of optimal glycemic control needs to be emphasized in patients with gastroparesis since hyperglycemia can delay gastric emptying, further deteriorating blood glucose control. Moreover, if the effect of exogenous insulin is unable to match with the carbohydrate that the patient consumes, this might lead to fluctuation of blood glucose. This case was a 33-year-old female with type 1 diabetes and gastroparesis, having a level of A1C at 10.3%. Her erratic glycemic control and severe symptoms of gastroparesis resulted in reduced food intake and weight loss. Nutritional diagnosis was altered GI function and food and nutrition-related knowledge deficit. The etiology was longer duration of diabetes and hyperglycemia, which induced diabetes gastroparesis and further required education about advanced carbohydrate counting as per instructions. Signs and symptoms included nausea and vomiting, reduced food intake, delayed gastric emptying (gastric emptying time 198 minutes, normal range 66 ± 32 minutes) and insufficient capability in handling carbohydrate counting. By calculation of carbohydrate intake, insulin to carbohydrate ratio 7, insulin sensitivity factor 65 was used to adjust insulin dosage and improve blood sugar control. Dietary education for gastroparesis was provided to this patient. Finally, the patient’s blood sugar and body weight was improved, hemoglobin A1C reduced from 10.3% to 7.6%, while body weight increased from 44.3 kg to 52.0 kg. The management for diabetic gastroparesis includes correcting the precipitating cause of gastroparesis, symptomatic relief, glycemic control, and dietary modification.

並列關鍵字

type 1 diabetes ； gastroparesis ； A1C ； medical nutrition therapy

國際替代計量

第1型糖尿病合併胃輕癱之營養照護個案報告

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