I. Background

  1. Subtype of Diabetic Neuropathy
  2. Affects sympathetic, parasympathetic and enteric nerves

II. Epidemiology

  1. Most common in >20 years of poor glycemic control

III. Cardiovascular Autonomic Neuropathy

  1. Orthostatic Hypotension
  2. Exercise intolerance
  3. Syncope
  4. Prolonged QT interval on Electrocardiogram
  5. Evaluate Heart Rate variability and stress test

IV. Gastrointestinal Autonomic Neuropathy

  1. Altered bowel habits (Diarrhea or Constipation)
  2. Gastric atony (Dysphagia, bloating, Nausea)
  3. Fecal Incontinence

V. Genitourinary Autonomic Dysfunction

  1. Bladder dysfunction
    1. Urinary Incontinence
    2. Urinary frequency
  2. Sexual dysfunction
    1. Erectile Dysfunction
    2. Loss of libido
    3. Anorgasmia
    4. Dyspareunia (associated with vaginal dryness)

VI. Miscellaneous autonomic symptoms

  1. Unaware of hypoglycemic episodes
  2. Abnormal pupil function
  3. Sudomotor Neuropathy (Sweat Gland dysfunction)
    1. Dry, pruritic skin
      1. Extremity Hair Loss

VII. Differential Diagnosis

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