What is Autonomic neuropathy?

Damage to the nerves that assist regulate the body’s automatic processes, including heartbeat and blood pressure, perspiration and temperature regulation, digestion, urine, and some aspects of sexual function, results in autonomic neuropathy.

Issues with the heart and blood vessels

Due to diabetic autonomic neuropathy, the nerves in the heart and circulatory system are damaged, causing an abrupt drop in blood pressure when you sit down or suddenly stand up (orthostatic hypotension).

When not exercising, your heart rate is rapid (resting tachycardia).

An unaccompanied cardiac arrest is one that does not cause chest discomfort (silent heart attack). 

A heart attack may go undiagnosed if there is no evidence of chest pain, which can cause serious damage to the heart. 

The only indications of a heart attack in someone with diabetes and neuropathy could be an increase in blood sugar, weakness that does not improve after eating, breathing difficulties that get worse, nausea, and occasionally swelling in the legs.

Problems with temperature regulation and perspiration

The neurons that control sweating may be impacted by autonomic neuropathy.

Reduced sweating is typical, especially in the hands and feet. Given that one of the primary signs of low blood sugar is sweating, it could be challenging to identify when your blood sugar is lowering. Dry skin might develop and become more prone to damage, infection, and cracking. It is possible to have excessive sweating of the neck, face, or body at night or when eating.

Changes in the body’s capacity to control temperature may increase your risk of developing heat-related illnesses including heatstroke or heat exhaustion as well as bodily cooling (hypothermia).

Digestive system problems

As a result of the intestines’ excessively long transit time for waste, damage to the nerves of the stomach and intestines may result in: 

• In persons with diabetes, this is the most typical digestive issue.
• Post-meal delayed emptying of the stomach (gastroparesis). Frequent belching, heartburn, nausea, and/or vomiting may result from this.
• Diarrhea caused by an unusually fast rate of waste elimination in the intestines. In the evenings, diarrhea is more frequent.
• Stomach ache

Issues with urine and sexual function

The bladder and genital organs may experience issues as a result of nerve injury. Regular issues include:

• Diabetic cystopathy, which causes difficulties emptying the bladder entirely as well as problems recognizing when it is full.
• The frequent occurrence of urinary tract infections (UTIs). Damage to the nerves might prevent the bladder from emptying properly, increasing the risk of infection.
• Difficulty for men getting or keeping an erection during sexual activity (impotence).
• For females, lessening of clitoris feeling and vaginal wetness.

Autonomic neuropathy can be incapacitating despite typically not being life-threatening. Some of the issues produced by diabetic autonomic neuropathy are effectively treated.

Symptoms of autonomic neuropathy

In addition to heart and blood vessel function, including blood pressure, autonomic neuropathy may have an impact on digestion, the body’s capacity to control temperature, urine, sexual function, and temperature regulation. Pregnancy-related symptoms could worsen. Symptoms may generally consist of:

• Constipation, heartburn, frequent bloating and belching, nausea and vomiting, diarrhoea, and abdominal discomfort. These signs could indicate gastroparesis, which causes the stomach to empty considerably more slowly than it should.
• Excessive perspiration on the torso, face, or neck at night or while consuming particular foods, such as cheese and spicy dishes. Some persons may have less perspiration overall, particularly in their legs and feet.
• Difficulties recognising when the bladder is full or having trouble fully emptying the bladder.
• Issues with the erection in men and the dryness of the vagina in women.
• Feeling lightheaded, weak, or faint when you stand or sit up after lying down (orthostatic hypotension).
• Difficulty recognising when your blood sugar is low (hypoglycemia unawareness).

Treatment for autonomic neuropathy

Digestive function, urine, sweating, sexual function, blood pressure, and other automatic bodily processes can all be impacted by autonomic neuropathy, which affects the nerves that control internal processes. Despite the fact that certain autonomic neuropathy symptoms are difficult to treat, others are treatable:

Mild constipation: Eating small, frequently spaced meals that are high in fibre and low in fat may be beneficial.

Diarrhea on a regular basis: Consuming foods high in fibre may be beneficial. You might require antibiotics like amoxicillin, metronidazole, or tetracycline, or you might require medications that limit the rate at which food and waste pass through the intestines after being digested.

Mild gastroparesis: The stomach empties exceedingly slowly as a result of this disorder. If you consume little, often spaced meals that are low in fat and fibre, it might get better. There may also be a need for medications that promote faster stomach emptying. Keeping blood sugar under control may lessen gastroparesis symptoms.

Abnormal perspiration: Try to stay away from extreme heat and humidity if you perspire a lot. Use moisturizers if you don’t perspire enough to prevent dry or cracked skin. Increasing your water intake can help you stay cool. Avoid locations that are extremely hot or chilly.

Ignorance of low blood sugar levels: This is sometimes referred to as hypoglycemic ignorance. You can change your insulin dosage and allow your blood sugar levels to slightly exceed the desired range. Typically, it is advised that you maintain an A1c within a target range.

Urinary issues:  Antibiotics for urinary tract infections and medications to enhance bladder control can be used to treat urinary issues.

Sexual issues: Your doctor might advise taking medications or employing equipment to help with erections. Or you could require over-the-counter lubricants and lotions containing oestrogen to treat dry vagina.

Hypertension issues: Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril and enalapril, can be used to treat high blood pressure. Treatment for low blood pressure includes medication and the usage of support stockings (also called compression stockings).