Table 2.

Suggested management of hypomagnesemia in patients with type 2 diabetes

Increase Mg intake
    dietary consult
    high Mg-containing food types
        soy products, legumes, and seeds such as almonds and cashews, whole grains, and fruits and vegetables such as spinach, okra, Swiss chard, dried apricots, and avocados
Control of diabetic gastroparesis
    eat multiple small meals instead of two to three large meals per day
    tight glucose control
    use of prokinetic medications to enhance gastric motility
    others: pyloric botulinum toxin injection, enteric feeding, gastric pacing
Oral Mg supplementation
    see Table 3
Decrease gastrointestinal loss (diarrhea)
    trial of soluble fiber
    regular effort to move bowels
    trials of gluten-free diet, lactose restriction
    others: cholestyramine, clonidine, somatostatin analog, supplemental pancreatic enzyme, and antibiotics such as metronidazole
Decrease renal Mg loss
    decrease filtered load
        use angiotensin-converting enzyme and/or angiotensin receptor blockers
        tight glycemic control
        avoid excessive volume replacement during periods of hyperglycemia
Increase renal reabsorption
    tight glycemic control; measures to decrease insulin resistance (exercise)
    replacement of phosphate and potassium as needed
    replacement of diuretic-induced magnesiuria (based on a 24-h urine collection)