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35,36 Gastroparesis The term gastroparesis diabeticorum was coined by Paul Kassander in 1958 when describing increased gastric retention of barium in people with diabetes treated with insulin, who were notably asymptomatic

constipation, reflux, or intermittent nausea may continue Persistent or progressive symptoms rather than gradual improvement After month 3 Symptoms may remain mild or infrequent at a tolerated regimen New severe symptoms should not automatically be blamed on the medication The most important pattern is not simply "week 1 is bad and month 3 is good." A more accurate pattern is initiation, adaptation, possible symptom flare during dose escalation, and reassessment based on tolerability