Gastrointestinal upset following improvement of HbA _1c on initiation of pump therapy

Continuous subcutaneous insulin infusion therapy is being increasingly used across the world in our armamentarium to improve blood glucose control in type 1 diabetes. Significant and rapid declines in HbA_1c can be achieved because of the potential to reduce hypoglycaemic episodes and, whilst this is one of our goals in diabetes management, we must be conscious of the possible adverse effects of this. Here we report a case of transient gastroparesis with small bowel bacterial overgrowth following initiation of insulin pump therapy and a rapid drop in HbA_1c. Copyright © 2009 John Wiley & Sons.