Dear Colleague,
Case Challenge #9: He Lost Weight. Now Food Seems to Sit for Hours.
“The weight is finally coming off—but I can barely finish a meal.”
A 62-year-old man with an eight-year
history of type 2 diabetes comes to you with persistent nausea, bloating, and uncomfortable fullness after eating.
Five months ago, he began weekly semaglutide. He has lost 24 pounds, and his A1c has improved.
But after his most recent dose increase,
meals became difficult.
“A few bites feel like Thanksgiving dinner,” he says. “Sometimes I still feel full when it’s time for my next meal.”
He reports no similar symptoms before starting the medication. He remains able to drink fluids and has no
severe abdominal pain, bleeding, or persistent vomiting.
His medical evaluation includes:
- Upper endoscopy: No mechanical obstruction identified.
- Four-hour gastric-emptying study: 28% of the meal
remains at four hours; the laboratory’s upper limit is 10%.
- Glucose at the start of testing: 142 mg/dL.
He continued his weekly semaglutide throughout the testing period. His last injection was three days before the study.
He brings the report to your office.
“I was told this could be diabetic gastroparesis. Does this mean diabetes has permanently damaged my stomach?”
Which Is the Best Interpretation and Next Step?
A. The study documents delayed emptying, but does not establish whether diabetes, semaglutide, or both contributed. Coordinate medication review and a plan for symptom management and reassessment with her prescribing clinician and gastroenterologist.
B. His diabetes history and abnormal study establish diabetic
gastroparesis. Begin planning long-term management on that basis while continuing semaglutide unchanged.
C. The timing establishes semaglutide as the sole cause. Recommend stopping it permanently and consider the diagnostic question resolved.
Think of yourself as a clinical problem solver? Put your reasoning to the test. Choose your answer before reading the explanation.
SEE THE ANSWER &
CLINICAL REASONING →
Your Case Answer Comes with a Free FMU Sample Lesson
On the answer page, you’ll also find a free presentation by
Dr. Silverman: “Fueling Vitality: The Role of GLP-1 in Enhancing Mitochondrial Health and Longevity.” It’s one of many lessons in
FMU’s nearly 500 hours of educational presentations—an opportunity to experience the depth of our teaching while exploring GLP-1 from another clinical perspective.
SEE THE CASE ANSWER AND ACCESS YOUR FREE LESSON →
Warmly,
Ron Grisanti, D.C.
Founder, Functional Medicine University
P.S. Before turning an abnormal result into a lasting diagnosis,
ask whether a medication could have influenced what the test measured.
Explore the explanation for the distinction—and the practical question to ask before the next test.
