Diabetic Autonomic Neuropathy

Overview

Diabetic autonomic neuropathy is damage to the autonomic nerves caused by diabetes. These nerves control things like your heartbeat, blood pressure, sweating, digestion, urination, and sexual function.

Heart and circulatory system problems

Diabetic autonomic neuropathy may damage the nerves in the heart and circulatory system, causing a:

• Sudden drop in blood pressure when you sit or stand up suddenly (orthostatic hypotension).
• Rapid heart rate when you are not exercising (resting tachycardia).
• Heart attack that causes no chest pain (silent heart attack). Without the symptom of chest pain, a heart attack may be ignored, which can result in severe damage to the heart. The only signs of a heart attack in a person with diabetes and neuropathy may be a rising blood sugar level, weakness that does not go away after eating, increasing shortness of breath, nausea, and occasionally swelling in the legs.

Sweating and temperature regulation problems

Autonomic neuropathy may affect the nerves that control sweating.

• Reduced sweating is common, especially in the hands and feet. It may be hard to recognize when your blood sugar is dropping because sweating is one of the main symptoms of low blood sugar. You can develop dry skin that may be more prone to cracking, injury, and infection. Profuse sweating of the torso, face, or neck may occur at night or while eating certain things, like hot or spicy food.
• Changes in the body's ability to regulate temperature may make you more prone to body chilling (hypothermia) or heat-related illness, such as heatstroke or heat exhaustion.

Digestive system problems

Damage to the nerves of the stomach and intestines may cause:

• Constipation, because of abnormally slow passage of waste through the intestines.
• Delayed stomach-emptying after a meal (gastroparesis). This may cause frequent bloating, belching, heartburn, nausea, or vomiting.
• Diarrhea, because of abnormally fast passage of waste through the intestines. Diarrhea is more common at night.
• Belly pain.

Sexual function and urination problems

Nerve damage may cause problems with the bladder and sex organs. Common problems include:

• Trouble knowing when the bladder is full and difficulty emptying the bladder completely.
• Frequent urinary tract infections (UTIs). Nerve damage can disrupt the proper emptying of the bladder, which increases the risk of infection.
• For men, trouble achieving or maintaining an erection during intercourse (impotence).
• For women, decreased moisture in the vagina and reduced sensation of the clitoris.

Treatment for diabetic autonomic neuropathy

Treatment focuses on managing the symptoms of autonomic neuropathy. For example, taking medicines and eating small, frequent meals that are low in fibre and fat may help digestive problems like gastroparesis. Or you may take medicines for urinary or blood pressure problems. Medicines, lubricants, and creams may help with sexual problems.