Semaglutide caused gastroparesis requiring hospitalization after skipping dose titration steps | Research

The takeaway

A 48-year-old diabetic woman developed gastroparesis with acute kidney injury and colitis after resuming semaglutide at 2 mg weekly without the recommended stepwise dose escalation.

Skipped titration = gastroparesis
Restarting semaglutide at full dose (2 mg) without titration caused stomach paralysis, kidney injury, and colitis requiring hospitalization

What the researchers found

Gastroparesis after semaglutide 2 mg resumed without titration. Complications: AKI from dehydration + left-sided colitis. Treatment: metoclopramide + semaglutide cessation → resolution.

Why it matters

Many patients restart GLP-1 drugs at prior doses after breaks, not realizing the body loses tolerance. This case demonstrates that dose re-titration is essential to prevent serious GI complications.

How the study worked

Single case report.

What this study cannot tell us

Single case. Gastroparesis may have pre-existed. Other contributing factors possible. Cannot establish incidence.

How to read the evidence

Single case report.

When this study was published

Published in 2025.

The bigger picture

As GLP-1 drug shortages lead to on-off-on usage patterns, cases like this will become more common. Re-education about dose titration after treatment breaks is critical.

Questions still open

Should all GLP-1 restarters undergo full dose re-titration?
Does diabetic gastroparesis predispose to semaglutide-induced GI complications?
How common is gastroparesis with rapid GLP-1 dose escalation?

Common questions

What happens if you restart semaglutide at the full dose?

This case shows it can cause gastroparesis (stomach paralysis), which led to severe nausea, vomiting, dehydration, kidney damage, and colon inflammation. The recommended approach is to always restart from the lowest dose (0.25 mg) and gradually increase, even if you were previously on a higher dose.

What is gastroparesis?

Gastroparesis is a condition where the stomach cannot empty food normally, causing nausea, vomiting, and discomfort. GLP-1 drugs intentionally slow stomach emptying (which helps with appetite control), but too much too quickly—especially without dose titration—can effectively paralyze the stomach.

Read the original research

Unmasking Semaglutide-Induced Gastroparesis: The Dangers of Rapid Dose Escalation in a Diabetic Patient.

Cureus, 17(9), e91679

View on PubMed ↗Publisher’s paper ↗

Citation

Singhal, Rohan; Sachdeva, Dheerja; Wortman Ii, Kevin; Lall, Rekha. (2025). Unmasking Semaglutide-Induced Gastroparesis: The Dangers of Rapid Dose Escalation in a Diabetic Patient.. Cureus, 17(9), e91679. https://doi.org/10.7759/cureus.91679