Endocrine Abstracts

Woman, 40 years old. Smoker and habitual drinker, history of toxic consumption, anxiety-depressive syndrome, postsurgical hypothyroidism after total thyroidectomy for multinodular goiter in substitution treatment. Diabetes mellitus type 1 diagnosed in 2001 as a result of pregnancy, unstable, with poor chronic glycemic control, requiring frequent admissions to our hospitalization plant due to episodes of ketoacidosis. It requires high insulin requirements and does not present micro or macrovascular complications. Chronic diarrhea occurs since 2013, with up to 4 stools per day, accompanied by nausea and vomiting of food content, which worsens the control and glycemic stability, with frequent moderate-severe inadvertent hypoglycemia and hyperglycemia that was usually complicated by episodes of ketoacidosis moderate-severe diabetic To this is added the development of severe malnutrition, with a loss of 14 kg in the last 6 months. The complementary tests ruled out celiac disease, bacterial superinfection and other causes of chronic diarrhea. Abdominal CT, colonoscopy, TEGD without findings. The EDA checked food debris in the gastric chamber after 12 hours of fasting and autonomic neuropathy test showed an expiration/inspiration index, index 30/15 and abnormal Valsalva index confirming the diagnosis, without being able to rule out a certain component of associated diabetic enteropathy. Due to the important and severe metabolic and nutritional repercussion, we decided to start nutritional support. Which route of administration and type of formula will be the most suitable for our patient to manage?