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Diabetic Autonomic NeuropathyAka: Autonomic Neuropathy in Diabetes

Background
1. Subtype of Diabetic Neuropathy
2. Affects sympathetic, parasympathetic and enteric nerves
Epidemiology
1. Most common in >20 years of poor glycemic control
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
Gastrointestinal Autonomic Neuropathy
1. Altered bowel habits (Diarrhea or Constipation)
2. Gastric atony (Dysphagia, bloating, Nausea)
3. Fecal Incontinence
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)
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
Differential Diagnosis
1. See Autonomic Neuropathy
References
1. Vinik (2003) Diabetes Care 26:1153

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.