Autonomic Neuropathy : Symptoms, causes and treatment

World Diabetes Day is 14th November. It’s such a prevalent and important issue that we would like to discuss autonomic neuropathy in a bit more detail with you.

Neuropathy is the collective word for damage to nerves, it is one of the most common diabetes- related complications. Around 60-70% of people with diabetes have some level of neuropathy. There are 2 main forms:

Peripheral Neuropathy (Sensory and Motor):

This is damage to the nerves in the periphery, such as your hands and feet. The feet are often the first place you experience problems because the nerves in the feet are furthest from the brain and the spinal cord. Damage to the peripheral nerves can interfere with your ability to feel pain.

Diabetic Autonomic Neuropathy (DAN):

Often simply referred to as autonomic neuropathy and is a serious and often overlooked complication of diabetes. DAN is damage to the nerves that control involuntary bodily functions and your internal organs, such as your stomach, bladder, heart, blood vessels and sweat glands.

What causes Diabetic Autonomic Neuropathy?

Over time, high blood glucose and high levels of fats in the blood, such as triglycerides, can damage your nerves and the small blood vessels that sustain your nerves, leading to diabetic autonomic neuropathy. DAN usually presents alongside other diabetes complications, such as peripheral neuropathy. It makes sense that if nerves in other parts of your body could similarly be affected. However, DAN can occur on its own, or may be diagnosed before other diabetes-related complications are recognised.

What are the symptoms of Autonomic Neuropathy?

The symptoms will depend on which of your body’s functions are affected and can include any, or a combination, of the following:

Gastro-intestinal disturbances such as bloating, nausea, gastroparesis, constipation, diarrhoea (especially at night), and faecal incontinence (the inability to control bowel movements).

Urinary and genital tracts (reproductive organs), including bladder problems such as recurrent urinary tract infections, kidney infections, incontinence and sexual dysfunction.

Cardiovascular autonomic neuropathy symptoms include tachycardia (a rapid heartbeat while resting, orthostatic hypotension (also called postural hypotension – a form of low blood pressure when you stand up from sitting or lying down). Also people with cardiovascular autonomic neuropathy are at double the risk of silent myocardial ischaemia (heart attacks) and mortality (death).

Also, Diabetic Autonomic Neuropathy can cause Sudomotor Dysfunction which means that the thermos-regulatory sweating, the way your body keeps cool, is damaged. It tends to occur in a glove and stocking distribution initially. This means that in the beginning it will affect the hands and feet, by making them dry and crack, but over time it can extend further up the limbs and into the abdomen. Eventually it results in “global anhidrosis”, the inability to sweat at all. This is even more dangerous, as when you don’t sweat your body can’t cool itself, which can lead to overheating and potentially heatstroke.

Some people with sudomotor dysfunction can experience excessive sweating, as the body’s way to compensate. Gustatory sweating is an abnormal production of sweat that occurs soon after eating food. The sweating begins on the forehead and then spreads to the face, scalp and neck.

Other ways Diabetic Autonomic Neuropathy may make itself known is through:

· Impaired neurovascular function such as loss of sensation and numbness.

· Exercise intolerance

· Hypoglycaemic autonomic failure – defective glucose counter-regulation in hypoglycaemia (low sugar levels) and hypoglycaemia unawareness.

How is Diabetic Autonomic Neuropathy diagnosed?

Doctors diagnosed DAN based on your symptoms, family and medical history, a physical exam which includes checking your heart rate and blood pressure (while you are lying down and after standing up) and other tests to check for different types of autonomic nerve damage.

How common is Diabetic Autonomic Neuropathy?

It is not exactly known how many people suffer from DAN but it is estimated that around 20% of people with diabetes have symptoms suggestive of DAN.

Prevention and Screening

Knowledge of early autonomic dysfunction can encourage you to help treat autonomic neuropathy by keeping your blood glucose levels, blood pressure and cholesterol as close to your target as possible. Reducing alcohol intake and stopping smoking can keep nerve damage from getting worse.

Your ProMed Podiatrist is highly skilled and experienced in performing diabetes foot risk assessments as part of your annual cycle of care. If you have any concerns regarding your foot health, please contact us to book your assessment.

HEALTHY FEET ARE HAPPY FEET!

Raechel Farquharson, Podiatrist.

Article adapted from Circle : Living with diabetes Magazine No.26 Winter 2021 – Author Carolien Koreneff)