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Autonomic Neuropathy

Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Autonomic neuropathy also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response, and vision.

Symptoms vary depending on the nerve(s) affected. They usually develop gradually over years.
– Digestive tract :
* Constipation
* Diarrhea
* Feeling full after only a few bites (early satiety)
* Nausea after eating
* Swollen abdomen
* Unintentional loss of more than 5% of body weight
* Vomiting of undigested food
– Heart :
* Sensation of what is going on in the heart is blunted.
* Blood pressure changes with position.
* Dizziness that occurs when standing up.
* Lacking oxygen, the heart feels pained, a condition called angina. But a diabetic may not feel anything, or realize anything is wrong.
– Urinary tract :
* Difficulty beginning to urinate.
* Feeling of incomplete bladder emptying.
* Urinary incontinence (overflow incontinence).
– Other symptoms :
* Abnormal sweating
* Fainting
* Heat intolerance, induced by exercise
* Male impotence
Occasionally, other symptoms may indicate a problem in the function of the autonomic nervous system, including:
* Difficulty swallowing
* Excessive sweating
* Irregular heart rhythms
* High blood pressure
* Rapid or slow heart rate

Treatment is supportive and may need to be long-term. Several treatments may be attempted before a successful one is found.
* Florinef and salt tablets to increase fluid volume in blood vessels.
* Fludrocortisone or similar medications to reduce postural hypotension.
* Medications to help with salt and fluid retention.
* Proamatine to prevent a drop in blood pressure when standing.
* Sleeping with the head raised.
* Use of elastic stockings.
Treatments for reduced gastric motility include:
* Medications that increase gastric motility (such as Reglan).
* Sleeping with the head raised.
* Small, frequent meals.

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