Diabetic autonomic neuropathy

The neurological damage in diabetes tends to affect the parasympathetic arm of the autonomic nervous system, in particular vagal disturbance is a feature, e.g. causing nocturnal diarrhoea.

Other features include:

• GI: Abdominal discomfort, dysphagia, nausea, faecal incontinence, constipation, diarrhoea
• Cardiac: Hypotension, sinus tachycardia, variable heart rate, syncope
• Bladder: Weak urinary stream, straining to void, incomplete emptying of bladder,
• Skin: Heat intolerance, gustatory sweating, extreme diaphoresis
• Nervous: Carpal tunnel syndrome, radiculopathy, lumbosacral, cervical neuropathy, and impairment of cranial nerves III, IV, VI, and VII

Plus:

• erectile dysfunction
• dependent oedema
• hypoglycaemia unawareness

Management:

• see linked item management of diabetic neuropathy