Table 7. Clinical Features, Diagnosis, and Treatment of Diabetic Autonomic Neuropathy Tests
Symptoms Cardiac
Resting tachycardia, exercise intolerance
Postural hypotension, dizziness, weakness, fatigue, syncope
Gastrointestinal (GI)
Gastroparesis, erratic glucose control
Abdominal pain, early satiety, nausea, vomiting, bloating, belching
Constipation
Diarrhea (often nocturnal alternating with constipation)
Sexual dysfunction Erectile dysfunction
Vaginal dryness Bladder dysfunction
Frequency, urgency, nocturia, urinary retention, incontinence
Sudomotor dysfunction
Anhidrosis, heat intolerance, dry skin, hyperhidrosis
Pupillomotor and visceral dysfunction
Vision blurring, impaired light adaptation to ambient light, Argyll-Robertson pupil
Impaired visceral sensation: silent myocardial infarction, hypoglycemia unawareness
Quantitative sudomotor axon reflex, sweat test, skin blood flow
Pupillometry, HRV
Physical assessment/ medical history
Care with driving at night
Recognition of unusual presentation of myocardial infarction, control of risk factors, control of plasma glucose levels
13
Emollients and skin lubricants, scopolamine, glycopyrrolate, botulinum toxin, vasodilators
Cystometrogram, postvoiding sonography
Bethanechol, intermittent catheterization
Gastric emptying study, barium study
Endoscopy, manometry, electrogastrogram
Endoscopy None
Frequent small meals, prokinetic agents (metoclopramide, domperidone, erythromycin)
Antibiotics, antiemetics, bulking agents, tricyclic antidepressants, pyloric Botox, gastric pacing
High-fiber diet, bulking agents, osmotic laxatives, lubricating agents
Soluble dietary fiber, gluten and lactose restriction, anticholinergic agents, cholestyramine, antibiotics, somatostatin, pancreatic enzyme supplements
H&P, HRV, penile- brachial pressure index, nocturnal penile tumescence
None
Sex therapy, psychological counseling, 5'-phosphodiesterase inhibitors, prostaglandin E1 injections, devices, or prostheses
Vaginal lubricants
HRV, MUGA thallium scan, MIBG scan
HRV, supine and standing blood pressure, catecholamines
Treatments
Graded supervised exercise, ACE inhibitors, β-adrenergic blockers
Mechanical measures, clonidine, midodrine, octreotide, erythropoietin
