ABIM GI Practice Test 10

A 38-year-old woman with type 1 diabetes has gastroparesis confirmed by 4-hour scintigraphy (28% retention at 4 hours). Nausea and early satiety occur after most meals, and she vomits about twice weekly. She left school after the sixth grade and has difficulty reading; she says she "could not follow" the printed gastroparesis diet sheet she was given in the emergency department and threw it away. She eats two large meals daily, including raw salads, and her glucose readings fluctuate widely. Hemoglobin A1c is 9.6% (4.0%–5.6%). She has not received in-person dietary counseling or prokinetic therapy. Which of the following is the most appropriate next step in management?