What is diabetic autonomic neuropathy?

Autonomic neuropathy may affect certain processes in the body. This includes digestion, urination, sexual function, your body's ability to regulate temperature, and heart and blood vessel function, including blood pressure. Symptoms may include:

• Dizziness, weakness, or fainting when you stand or sit up from a reclining position.
• Feeling full after only a few bites of food, bloating, constipation, heartburn, nausea and vomiting, and belly pain. These symptoms may be a sign of gastroparesis. This causes the stomach to empty much slower than normal.
• Trouble sensing when your bladder is full or problems emptying your bladder completely.
• Sexual problems, such as erection problems or vaginal dryness.
• Trouble knowing when your blood sugar is low.
• Extreme sweating of the torso, face, or neck at night or while eating certain foods, such as spicy foods. Some people may have reduced sweating, especially in their feet and legs.

Treatment focuses on managing the symptoms of autonomic neuropathy. Some symptoms can be hard to manage, but others respond well to treatment. Here are examples of symptoms and treatments that may help.

Treatment for digestive problems

Mild constipation.

Eating small, frequent meals that are high in fiber and low in fat may help.

Frequent diarrhea.

Be sure to stay hydrated and avoid foods that make your symptoms worse. You may need medicines that slow digested food and waste traveling through your intestines.

Mild gastroparesis.

This condition causes the stomach to empty very slowly. Eating small, frequent meals that are low in fiber and fat may help. Medicines that help the stomach empty more quickly may also be needed. Controlling blood sugar levels may reduce your symptoms.

Treatment for other problems

Abnormal sweating.

If you sweat a lot, try to avoid intense heat and humidity. If you don't sweat enough, try moisturizers to help with dry or cracked skin. Drinking more water can prevent overheating. Try to avoid places that are very hot or very cold.

Lack of awareness of low blood sugar level (hypoglycemia unawareness).

Your doctor may adjust your insulin and allow your blood sugar levels to be a little bit higher than the target range. Usually it is recommended that you keep your A1c in a target range.

Urinary problems.

This can be treated with medicines to improve bladder control.

Sexual problems.

Your doctor may suggest using medicines or devices to improve erections. Nonprescription lubricants and estrogen creams may help with vaginal dryness.

Blood pressure problems.

High blood pressure may be treated with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril and enalapril. Low blood pressure can be treated with medicines and by wearing support stockings (also called compression stockings).

Heart and circulatory system problems

Diabetic autonomic neuropathy may damage the nerves in the heart and circulatory system, causing a:

• Sudden drop in blood pressure when you sit or stand up suddenly (orthostatic hypotension).
• Rapid heart rate when you are not exercising (resting tachycardia).
• Heart attack that causes no chest pain (silent heart attack). Without the symptom of chest pain, a heart attack may be ignored, which can result in severe damage to the heart. The only signs of a heart attack in a person with diabetes and neuropathy may be a rising blood sugar level, weakness that does not go away after eating, increasing shortness of breath, nausea, and occasionally swelling in the legs.

Sweating and temperature regulation problems

Autonomic neuropathy may affect the nerves that control sweating.

• Reduced sweating is common, especially in the hands and feet. It may be hard to recognize when your blood sugar is dropping because sweating is one of the main symptoms of low blood sugar. You can develop dry skin that may be more prone to cracking, injury, and infection. Profuse sweating of the torso, face, or neck may occur at night or while eating certain things, like hot or spicy food.
• Changes in the body's ability to regulate temperature may make you more prone to body chilling (hypothermia) or heat-related illness, such as heatstroke or heat exhaustion.

Digestive system problems

Damage to the nerves of the stomach and intestines may cause:

• Constipation, because of abnormally slow passage of waste through the intestines.
• Delayed stomach-emptying after a meal (gastroparesis). This may cause frequent bloating, belching, heartburn, nausea, or vomiting.
• Diarrhea, because of abnormally fast passage of waste through the intestines. Diarrhea is more common at night.
• Belly pain.

Sexual function and urination problems

Nerve damage may cause problems with the bladder and sex organs. Common problems include:

• Trouble knowing when the bladder is full and difficulty emptying the bladder completely.
• Frequent urinary tract infections (UTIs). Nerve damage can disrupt the proper emptying of the bladder, which increases the risk of infection.
• For men, trouble achieving or maintaining an erection during intercourse (impotence).
• For women, decreased moisture in the vagina and reduced sensation of the clitoris.

Diabetic autonomic neuropathy is damage to the autonomic nerves caused by diabetes. These nerves control things like your heartbeat, blood pressure, sweating, digestion, urination, and sexual function.

Autonomic neuropathy is caused by damage to the nerves that help control the involuntary functions of the body (autonomic nervous system), such as heartbeat and blood pressure, sweating and temperature regulation, digestion, urination, and some aspects of sexual function.