Table 7. Clinical Features, Diagnosis, and Treatment of
Diabetic Autonomic Neuropathy
Symptoms
Tests
Cardiac
Resting tachycardia, exercise HRV, MUGA
intolerance
thallium scan, MIBG
scan
Treatments
Graded supervised exercise, ACE
inhibitors, β-adrenergic blockers
Postural hypotension,
HRV, supine
dizziness, weakness, fatigue, and standing
syncope
blood pressure,
catecholamines
Gastrointestinal (GI)
Gastroparesis, erratic
Gastric emptying
glucose control
study, barium study
Mechanical measures, clonidine,
midodrine, octreotide,
erythropoietin
Abdominal pain, early
satiety, nausea, vomiting,
bloating, belching
Endoscopy,
manometry,
electrogastrogram
Antibiotics, antiemetics, bulking
agents, tricyclic antidepressants,
pyloric Botox, gastric pacing
Constipation
Endoscopy
High-fiber diet, bulking agents,
osmotic laxatives, lubricating agents
Diarrhea (often nocturnal
alternating with
constipation)
None
Soluble dietary fiber, gluten and
lactose restriction, anticholinergic
agents, cholestyramine, antibiotics,
somatostatin, pancreatic enzyme
supplements
H&P, HRV, penilebrachial pressure
index, nocturnal penile
tumescence
Sex therapy, psychological
counseling, 5'-phosphodiesterase
inhibitors, prostaglandin E1
injections, devices, or prostheses
None
Vaginal lubricants
Sexual dysfunction
Erectile dysfunction
Vaginal dryness
Frequent small meals, prokinetic
agents (metoclopramide,
domperidone, erythromycin)
Bladder dysfunction
Frequency, urgency,
Cystometrogram,
nocturia, urinary retention, postvoiding
incontinence
sonography
Bethanechol, intermittent
catheterization
Sudomotor dysfunction
Anhidrosis, heat
intolerance, dry skin,
hyperhidrosis
Quantitative sudomotor Emollients and skin lubricants,
axon reflex, sweat test, scopolamine, glycopyrrolate,
skin blood flow
botulinum toxin, vasodilators
Pupillomotor and visceral
dysfunction
Pupillometry, HRV
Vision blurring, impaired
Physical assessment/
light adaptation to ambient medical history
light, Argyll-Robertson
pupil
Care with driving at night
Impaired visceral sensation:
silent myocardial infarction,
hypoglycemia unawareness
Recognition of unusual presentation of
myocardial infarction, control of risk
factors, control of plasma glucose levels
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