Centres of Excellence -> Endocrinology and Diabetes -> Autonomic diabetic neuropathy

Autonomic diabetic neuropathy

Autonomic diabetic neuropathy is a form of damage to sympathetic and/or parasympathetic nerves in people with diabetes. The mortality of patients with cardiovascular autonomic neuropathy is 5-6 times higher in a period of 5-6 years than the mortality of patients with diabetes without autonomic neuropathy. The diagnosis is made based on symptoms, signs and autonomic nervous system test results.

A special difficulty is the late recognition of symptoms, and by then significant damage to the autonomic nervous system has already occurred. The loss of signs of hypoglycemia is of great importance, and in this case, more frequent self-monitoring of blood glucose is recommended and indicates the recognition of some of the unusual signs of hypoglycemia, such as tingling in the hands and feet.

Symptoms depend on the affected organ. Diabetic gastroenteropathy affects the digestive system, and it is a functional disorder of the passage of food. The first sign is facial sweating while eating, then there may be a feeling of heaviness in the upper abdomen, bloating, nausea, diarrhea and/or constipation, difficulty in stool control (stool incontinence).

In the case of frequent diarrhea, multiple mushy meals are recommended, and in case of constipation, food rich in fiber. In the case of gastroparesis, it is important to chew food well and stay upright for at least half an hour after each meal, it is preferable to avoid drugs that slow down gastric emptying, such as tricyclic antidepressants, calcium channel blockers, GLP-1 analogues.

The unpredictable passage of food through the alimentary canal is the cause of increased blood glucose oscillations, which is harmful to the development of chronic complications. Autonomic neuropathy of the cardiovascular system is manifested by exercise intolerance, accelerated heart rhythm at rest, arrhythmia and possible cardiac arrest, orthostatic hypotension, loss of circadian blood pressure rhythm.

In orthostatic hypotension, a drop in blood pressure occurs when standing up, so it is advised to tighten the feet and clench the fists tightly for a few seconds before standing up, and after standing up for a few seconds to tighten the leg muscles, wear elastic socks, increase salt and fluid intake, and omit medications that worsen orthostatic hypotension hypotension.

Autonomic neuropathy of the urogenital system is manifested by bladder dysfunction and sexual dysfunction in women and men.

Making a diagnosis of erectile dysfunction requires the teamwork of endocrinologists - diabetologists, neurologists, urologists, angiologists and psychologists.

For the treatment of erectile dysfunction in patients with diabetes, today we have vasoactive drugs as well as different types of prostheses and surgical interventions on blood vessels. Sexual disorders in women are more complex and harder to define as a problem. The reasons for sexual disorders in women are: reduction of sexual desire, dryness of the vagina, difficulty in achieving orgasm and painful intercourse.

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