Prandial Insulin Adjustments in the Context of Gastroparesis and Type 1 Diabetes: A Mixed Methods Study.

UNLABELLED: Gastroparesis (impaired gastric motility) is a complication of type 1 diabetes that impacts glycemic management. Yet, little research exists on prandial insulin adjustment strategies to manage this complex condition. This study combines current literature with clinical and lived experiences to propose practical strategies for insulin adjustment for people with type 1 diabetes and gastroparesis. METHODS: A mixed-methods approach was used. PubMed and Scopus were searched in February 2025, and Canadian clinicians and people with type 1 diabetes were surveyed using the Delphi method. Consensus was set at ≥80% agreement. Findings from both the review and panel informed the proposed recommendations. RESULTS: Of 2750 studies retrieved, seven met the inclusion criteria. Common themes included post-meal insulin dosing, dose reductions, and use of dual wave or extended boluses with insulin pumps and automated insulin delivery (AID) systems. The expert panel included 42 clinicians and 6 people with type 1 diabetes with gastroparesis. The panel recommended splitting the insulin dose (25-70% with meal and the remaining dose after 2-4 hours or as needed) for injection or non-automated insulin pump users. For AID users, recommendations included smaller insulin doses with the meal and allowing AID algorithms to manage postprandial glycemia. Participants emphasized individualized strategies based on symptoms, gastric motility and glucose monitoring. CONCLUSION: This study provides expert-informed strategies grounded in literature for adjusting prandial insulin when gastroparesis is present. The findings highlight the growing evidence that AID systems can reduce the burden associated with gastroparesis and continuous glucose monitoring can support timely dosing decisions.