We all know hypoglycemia occurring before food in a diabetic patient who is on OHA or insulin or both. But hypoglycemia occurring after food is an entity which does not get the attention which it deserves. This is a complication of diabetes resulting in a condition known as diabetic gastro paresis. There is an increased gastric emptying time in this condition. Early satiety, nausea, vomiting, postprandial abdominal fullness and abdominal pain are some of the features. Diabetes more profoundly affect gastric motor functions than the small bowel transit. This results prolonged food retention in the stomach. As required the patient would have taken insulin or OHA prior to food. The medication and the delayed food transit result in hypoglycemia. When we manage diabetes this paradoxical condition must be kept in the mind. To overcome this complication patient must be advised to take small frequent meal along with plenty of fluid. Larger volume of the food taken at one time will also delay gastric emptying. Fat content must be reduced. They must be instructed to chew the food well. Alfa glycosidase inhibitors such as acarbose and voglibose before food may facilitate gastric emptying.

UA Mohammed