Diabetic autonomic neuropathy

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Anatomy/distribution Both sympathetic and parasympathetic fibers are affected in diabetic autonomic neuropathy (DAN). Like DPN, DAN is a length dependent neuropathy with loss of autonomic function that can vary from mild to severe.

Symptoms Mild subclinical DAN is common and occurs in patients with DPN. Symptom atic DPN can vary from mild to severe. Cardiac symptoms include fixed tachycardia, orthostatic/postprandial hypotension, arrhythmias, and in severe cases, sudden cardiac death. Gastrointestinal symptoms include constipation, nightime diarrhea and gastroparesis with early satiety, nausea and vomiting. Genitourinary symptoms are common in men, with impotence present in nearly all males after 25 years of diabetes. Urinary retention occurs in men and women. Abnormal pupillary responses and abnormal sweating occurs, with anhydrosis of the feet and hands, and gustatory sweating in more severe cases. Abnormal neuroendocrine responses likely contribute to hypoglycemic un-awareness in type 1 patients.

Symptomatic DAN is more common in type 1 patients, although subclinical DAN (diagnosed by cardiovascular testing) is common in type 2 patients. The signs in DAN parallel the symptoms. Patients have an abnormal heart rate, poor cardiac beat to beat variation, orthostasis, weight loss from gastroparesis, urinary tract infections from urinary retention, poor pupillary responses and absent sweating.

Clinical syndrome/ signs

Pathogenesis Like DPN, it is generally held that hyperglycemia underlies the development of

DAN. It is likely that the hyperglycemic state disrupts both the normal metabolism and blood flow of autonomic ganglia and nerves.

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