Gastroparesis diabeticorum of the severity described is associated with a poor prognosis. It has been estimated that as many as 30% of patients may die within three years. The aim of treatment is to break the cycle of complications of diabetes, erratic nutrient absorption, and poor control of diabetes.

Exactly how poor is this patient's diabetes control? We know she is losing protein in the urine. Has she also a high haemoglobin A _ic concentration and measurable urinary glucose losses? The original diagnosis was anorexia nervosa. What is her body mass index? Is she continuing to lose weight? In the starved or malnourished state, …