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Diabetic Autonomic Neuropathy

Aka: Diabetic Autonomic Neuropathy, 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 26:1153-79

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 10/21/2007 and last published on 5/10/2012.

This is one of 5737 pages in the Family Practice Notebook