Neuro

Diabetic Autonomic Neuropathy

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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