Diabetic autonomic neuropathy

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Diabetic autonomic neuropathy
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Diabetes is a disease in which there is a disturbance in the way food is converted into energy in the body. Food essentially consists of sugars (carbohydrates), proteins, and fat. Sugars are the principle source of energy, while fats are energy stores for the body, which can be used when there is an inadequate sugar supply. The body uses the hormone insulin to turn sugar into fuel; this is produced in an organ called the pancreas. If there is an insulin deficiency, as occurs in diabetes, the body cannot use the sugars and the level of sugar rises in the blood. This condition is called hyperglycaemia.

What is diabetic neuropathy?
Diabetic neuropathy is a nerve disorder that arises as a complication of diabetes. High blood glucose levels and a decrease in blood flow cause nerve damage. Prolonged high blood glucose levels cause changes in the nerve structure and impair the functioning of the nerves. Injury to the nerves is more likely to develop in a diabetic with poorly supervised blood glucose levels.

What are the different types of diabetic neuropathy?
Diabetic neuropathy may be diffuse (affecting many parts of the body), or, may affect a single/specific nerve (thereby affecting a specific part of the body). Diffuse neuropathy is of two types, peripheral and autonomic neuropathy. Peripheral neuropathy is characterised by damage to the nerves of the limbs (especially the feet). Autonomic neuropathy is characterised by damage to the nerves of the various internal organs.

What is diabetic autonomic neuropathy?
Diabetic autonomic neuropathy is characterised by damage to the nerves of the various internal organs. Autonomic nerves work independently of conscious control affecting the functioning of the heart, digestive tract, sexual organs, urinary tract and sweat glands.

What are the symptoms of diabetic autonomic neuropathy?
Symptoms of diabetic autonomic neuropathy depend on the organs affected. When the heart is affected, the patient may feel faint, or, dizzy when sitting/standing, because of decrease in blood pressure. The patient may also not feel the pain of any underlying heart disease. Autonomic neuropathy can affect the nerves of the various organs of the digestive system and can lead to nausea, vomiting, loose stools or constipation (a condition in which the bowel movement is incomplete and infrequent), and inability to prevent the discharge of urine, or stools (incontinence). Abnormal digestion can lead to a fluctuating blood sugar levels. Problems with the digestive system often lead to weight loss.
Damage to the nerve supplying the urinary bladder may result in, incomplete emptying of the urinary bladder. This allows bacterial organisms to grow in the bladder and cause urinary tract infections. If the nerves supplying the sexual organs are damaged it can to lead to gradual loss of sexual response in both men and women. In men, it can also cause impotence (the inability of the male to achieve and/or maintain penile erection and thus an inability to engage in copulation). Damage to the nerves controlling the sweat glands can affect the ability of the body to regulate its temperature. The patient may experience too little or profuse sweating.

How is diabetic autonomic neuropathy diagnosed?
Diabetic autonomic neuropathy diagnosis is based on the symptoms and a thorough physical examination of the patient. A variety of neurological and sensory tests may be done to check for muscle strength, reflexes, and sensitivity to position, vibration and temperature.

What is the treatment of diabetic autonomic neuropathy?
Treatment of diabetic autonomic neuropathy aims at reducing discomfort and preventing further progression of the disease. Firstly, the blood sugar level is controlled by diet, oral medications or insulin injections, and a regular blood sugar monitoring is done. This may prevent or delay the onset of further problems. Drugs may be prescribed for treating diarrhoea and urinary tract infections. Patients with impotence may benefit from treatment with drugs (e.g. sildenafil citrate), or, from the use of vacuum devices to produce an erection.

Referenties
Diabetic Neuropathy, 2001[Online] Available: http://www.nlm.nih.gov/medlineplus/ency/article/000693.htm [2001, Aug. 08].

Frier, B.M., Truswell, A.S., Shepherd, J., et al. 1999, "Diabetes mellitus, and nutritional and metabolic disorders, in Davidson's Principles and Practice of Medicine, eds C. Haslett, E.R.E. Chilvers, J.A.A. Hunter, & N.A. Boon, 18th edn, Churchill, Livingstone, London.

Spencer S. Pressure relieving interventions for preventing and treating diabetic foot ulcers (Cochrane Review), in The Cochrane Library, 3, 2001, Oxford: Update Software.