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DIABETES AND NEUROPATHY
Autonomic neuropathy
This is a form of nerve damage that affects the nerves controlling such functions as blood pressure, erection of the penis, bowel action and bladder emptying. Autonomic neuropathy is not usually noticed by the person with diabetes; it causes no problems and is detected only by sophisticated testing. Just occasionally it does cause sufficient disturbance of these functions to be noticed:
? Postural hypotension: poor blood pressure control may cause postural hypotension, which is a fall in blood pressure on standing. This may make you feel dizzy when you get up from a chair or bed. Wearing supportive stockings to prevent pooling of blood in the legs may help. Drugs such as fludrocortisones may reduce the pressure drop.
? Diabetic bowel and bladder: autonomic neuropathy which involves the bowel may cause diarrhea, and this may be especially troublesome at night. It can settle by itself. If not, the diarrhea may improve with tetracycline (antibiotic) treatment.
Incomplete emptying of the bladder is another effect, and occasionally leads to urinary tract infection in the urine that is not lost. Playing special attention to bladder emptying may improve this problem.
? Impotence caused by autonomic failure of erection.
Loss of hypoglycemic warnings
One practical problem for insulin-treated diabetics thought to be due to autonomic neuropathy is the reduction or loss of the warning symptoms of hypoglycemia. This does not necessarily apply to everyone with autonomic neuropathy; on the other hand, over the years the warning of hypoglycemia may be harder to recognize in people with no other signs of autonomic neuropathy. Bear these points always in mind:
1. Transient tingling of the hands or feet is common before diabetes is diagnosed and usually settles with treatment.
2. Tingling or numbness in the feet may develop over the years.
3. If you have numb feet, examine them every night for minor injuries. Do not walk barefoot. Choose your shoes carefully.
4. Have regular check-ups for neuropathy.
5. Good glucose control may prevent the development of neuropathy, and improve it if symptoms have become apparent.
6. Symptomatic autonomic neuropathy is uncommon and many of its features are treatable.
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