Diabetic Autonomic Neuropathy
Diabetic autonomic neuropathy (DAN) may involve the following:
1- Cardiovascular autonomic neuropathy (CAN) leads to orthostatic hypotension, resting tachycardia and exercise intolerance. On EKG you can find shortened or prolonged R-R interval. Valsalva maneuver might help with diagnosis. Treatment depends on the symptoms and might include midodrine for hypotension and beta blockers for exercise intolerance.
2- Gastrointestinal autonomic neuropathy (GAN) leads to various manifestations including gastroparesis, esophageal issues like GERD and dysphagia, fecal incontinence and constipation that might be alternating with diarrhea. Treat constipation/diarrhea with fiber diet and laxatives and medications as indicated like anticholinergics and clonidine. Treat gastroparesis with prokinetic agents like erythromycin and eating frequent smaller meal portions. Surgical intervention might include gastric pacing and pyloric Botox. Some patients might need enteral feeding.
3- Genitourinary autonomic neuropathy leads to bladder dysfunction like incontinence or retention which can lead to recurrent infections. It can also lead to retrograde ejaculation and erectile dysfunction.
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This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services or your primary care provider. Please refer to your doctor for medical advice.