Diabetic gastroparesis is a common, underrecognized disorder affecting both type I and type II diabetics usually in the setting of other diabetic complications. The pathogenesis of diabetic gastroparesis is poorly understood, but autonomic neuropathy appears to play a major role. The symptoms of gastroparesis are nonspecific, and complications such as hypoglycemia and bezoar formation due to gastric stasis may occur. Diabetic gastroparesis can be assessed by measuring the gastric emptying of solid radiopaque markers or by scintigraphy. Treatment approaches include optimizing glycemic control and the use of prokinetic agents. Combination therapy or the alternating use of prokinetic agents may prove to be beneficial in dealing with drug tachyphylaxis.