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Autonomic Neuropathy

If you live with diabetes, you may be familiar with the numbness and pain caused by peripheral neuropathy, or nerve damage. But you may not be as familiar with the form of diabetes-related nerve damage known as autonomic neuropathy.

The autonomic nervous system controls the involuntary functions of the body, such as:

• heart rate
• blood pressure
• bladder function
• digestion
• vision
• salivation
• perspiration

Autonomic neuropathy attacks and damages the nerves that manage these functions. It can be more difficult to recognize and to diagnose than peripheral neuropathy because it short-circuits bodily functions rather than causes pain or obvious numbness.

Autonomic neuropathy can cause a wide range of symptoms, depending on the nerves that are affected. Symptoms can include:

• incontinence
• constipation
• diarrhea
• dizziness
• sweating too much

These are also common symptoms of a number of other medical conditions, so autonomic neuropathy can be hard to diagnose. Often, a diagnosis isn't made until organ damage has occurred.

The Types of Autonomic Neuropathy

Cardiovascular Autonomic Neuropathy

Although it can cause severe cardiovascular problems and sudden death, surveys show that only 2% of people with diabetes are tested for cardiovascular autonomic neuropathy (CAN).

Gastroparesis

Gastroparesis, sometimes called delayed stomach emptying, is caused by nerve damage to the digestive tract. In addition to causing gastrointestinal distress, gastroparesis can also affect blood sugar levels. Symptoms include vomiting, nausea, reflux, weight loss, heartburn, and feeling full early. There are several drug options and investigational devices available for treatment.

Neurogenic Bladder

Nerve damage to the urinary bladder can cause incontinence, urinary tract infections, and kidney disease. Unfortunately, patients often feel too embarrassed to report their symptoms to their healthcare provider.

Sudomotor Neuropathy

Nerve damage to sweat glands can cause you to sweat too much and lead to dry skin. This can lead to infection and heat stroke.

Hypoglycemic Unawareness

People with hypoglycemic unawareness do not experience the normal symptoms of low blood sugar, such as sweating and rapid heartbeat, that act as a warning system for people with diabetes. They can go dangerously low and even lose consciousness before realizing that their blood sugar is low. If you don't experience the usual symptoms associated with hypoglycemia, make sure you test your blood sugar more often.

Impotence

Neuropathy is one potential cause of erectile dysfunction, and can play a part in female sexual dysfunction as well.

Visual Impairment

Ocular nerve damage can affect eyesight, especially night vision.

How to Treat and Prevent Autonomic Neuropathy

Controlling your blood sugar is the best way to prevent serious neuropathy complications. You should check your blood sugar often, and speak with your healthcare team about your diet, exercise, and medicine medication plan.  

Treatment of autonomic neuropathy depends on the nerves that are affected and the symptoms you have. Treatment often focuses on managing your symptoms and preventing further complications.

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Reviewed by Susan Weiner, RD, MS, CDE, CDN 03/13