BY AMY CAMPBELL, MS, RD, LDN, CDCES | OCTOBER 5, 2022
Neuropathy is a term that means nerve damage, and it happens to be one of the longer-term complications of having diabetes. There are different types of neuropathies, and you might be familiar with a type called peripheral neuropathy, which is when nerves in the hands, arms, and feet get damaged. Another type of neuropathy is called autonomic neuropathy. What is this and how might you know if you have it? Read on to learn more.
What is autonomic neuropathy?
Autonomic neuropathy, simply put, is damage to the nerves that control your internal organs, says the National Institute of Diabetes and Digestive and Kidney Diseases.
This type of neuropathy can affect multiple organs and functions in the body, including:
- Blood pressure
- Heart rate
- Sweating
- Bowel and bladder emptying
- Digestion
- Ability to sense hypoglycemia (low blood sugar)
- Sexual function
Who gets this type of neuropathy?
People with diabetes can have autonomic neuropathy, as well as peripheral neuropathy. In fact, diabetes is the most common cause of autonomic neuropathy. But people with other health conditions may be susceptible, as well, including:
- Alcohol abuse
- Cancer
- Guillain-Barre syndrome
- HIV/AIDS
- Hypothyroidism
- Lupus
- Lyme disease
- Multiple sclerosis
- Parkinson disease
- Spinal cord injury
Autonomic neuropathy in people who have diabetes results from high blood sugar levels, as well as high levels of triglycerides (blood fats). High blood sugars and triglycerides damage nerves as well as the blood vessels that nourish the nerves.
What are some signs and symptoms of autonomic neuropathy?
Symptoms of this type of neuropathy depend on which organs and bodily functions are affected. Here are some examples.
Digestive organs
The nerves in the stomach and intestines can be impacted by autonomic neuropathy. Typical symptoms include:
- Swallowing difficulty
- Bloating and fullness
- Nausea and vomiting
- Diarrhea, either alone or alternating with constipation
- Fecal incontinence
You may feel full after eating a small amount of food; you might also notice that your appetite is lagging. If you have gastroparesis, a disorder in which the movement of food through the digestive tract is slowed or even stopped, that may be a result of autonomic neuropathy. Gastroparesis is a challenging condition to manage and can affect how your body uses glucose from food and insulin, making it challenging to keep blood sugars within a safe range.
Heart and lungs
Damage to the nerves that control your heart rate and blood pressure can cause:
- An abnormal heart rate
- A heart rate that can suddenly speed up or slow down
- Dizziness or fainting when you stand up due to a drop in blood pressure
- High blood pressure
- Inability to feel chest pain
- Shortness of breath when doing activity
Bladder and sex organs
If nerves that control the bladder and sex organs, you may have these symptoms
- Incomplete emptying of the bladder, raising the risk of urinary tract infections
- Leaking urine
- Difficulty knowing when you need to urinate
- In men, erectile dysfunction (trouble getting or keeping an erection)
- In women, problems with vaginal dryness, arousal and trouble having orgasms
Eyes
Autonomic neuropathy can affect the eyes; particularly, you may notice that it takes longer for your eyes to adjust to changes in light and darkness, due to nerve damage in the pupils. Night time driving might be affected if you notice that you have trouble seeing car head lights.
Sweat glands
Are you noticing that you are sweating more than usual? Or sweating when you eat? Other signs of nerve damage to the sweat glands include:
- Not sweating at all, even in hot weather
- Very dry skin, especially on the feet
Damage to the sweat glands means that your body has a problem regulating body temperature.
Hypoglycemia unawareness
If you are noticing that you aren’t getting symptoms of low blood sugar (hypoglycemia) anymore, you could have a condition called hypoglycemia unawareness. This condition can be caused by autonomic neuropathy. Usually, low blood sugar symptoms include feeling dizzy, hungry, nervous, confused, or irritable. But with nerve damage, you won’t feel these symptoms and that means that you won’t take steps to treat it. This is a dangerous situation, potentially causing severe hypoglycemia that could cause you to pass out.
How is autonomic neuropathy diagnosed?
The above symptoms could indicate other conditions besides autonomic neuropathy. That’s why it’s important to see your health care provider if you have any of these symptoms.
Your health care provider will ask you about your symptoms and do a physical exam. Depending on your symptoms, you might need certain tests:
- To rule out other causes of diarrhea or constipation (and you may be referred to a gastroenterologist)
- Urine and bladder tests to check your bladder function, including ultrasound
- Blood pressure monitoring when you lie down and after standing up
How is autonomic neuropathy treated?
Treatment of autonomic neuropathy depends on what organs or body functions are affected. For example, if your digestion is affected, treatment might consist of:
- Changes in your diet, including increasing fiber and fluid intake and eating small, frequent meals
- Medication to help your stomach empty, or to manage diarrhea or constipation
Bladder issues can be managed with medication, bladder retraining, or catheterization.
Blood pressure and heart rate issues can be managed with changes in diet (such as a lower- or even higher-sodium diet) or medications.
Sexual function issues can also be managed with medication or, for men, certain types of devices. Women may find vaginal lubricants to be helpful.
Excess sweating can be treated with medication to decrease sweating, prescription antiperspirants, and surgery to either cut the nerves to the sweat glands or to remove sweat glands.
Your health care team can also address lifestyle changes that can help you manage symptoms, too. For example, raising the head of the bed can help digestion as well as low blood pressure. Standing up slowly and prevent dizziness (and falling). Some people may find that acupuncture can be helpful with gastroparesis.
Don’t overlook the important of diabetes management. Aiming to keep your blood sugars within your target range as much as possible can help to lessen symptoms and may prevent or delay new symptoms. Work with your health care team on your diabetes treatment plan.
Again, reach out to your health care provider if you have any symptoms that could be signs of autonomic neuropathy. Treatments are available to ease and manage symptoms and improve your quality of life!
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