Clinical Manifestations

 Three manifestations of autonomic neuropathy are related to the cardiac, gastrointestinal,

and renal systems.
 Cardiovascular symptoms range from a fixed, slightly tachycardic heart rate and
orthostatic hypotension to silent, or painless, myocardial ischemia and infarction.
 Delayed gastric emptying may occur with the typical gastrointestinal symptoms of early
satiety, bloating, nausea, and vomiting.
 “Diabetic” constipation or diarrhea (especially nocturnal diarrhea) may occur as a result.
 In addition, there may be unexplained wide swings in blood glucose levels related to
inconsistent absorption of the glucose from ingested foods secondary to the inconsistent
gastric emptying.
 Urinary retention, a decreased sensation of bladder fullness, and other urinary symptoms
of neurogenic bladder result from autonomic neuropathy.
 The patient with a neurogenic bladder is predisposed to development of urinary tract
infections because of the inability to empty the bladder completely.
 This is especially true of patients with poorly controlled diabetes because hyperglycemia
impairs resistance to infection.

Hypoglycemic Unawareness
 Autonomic neuropathy affecting the adrenal medulla is responsible for diminished or
absent adrenergic symptoms of hypoglycemia.
 Patients may report that they no longer feel the typical shakiness, sweating, nervousness,
and palpitations associated with hypoglycemia. (pero meron padin)
 Frequent blood glucose monitoring is recommended for these patients.
 The inability to detect and treat these warning signs of hypoglycemia puts patients at risk
for development of dangerously low blood glucose levels.
 Therefore, goals for blood glucose levels may need to be adjusted to reduce the risk for
hypoglycemia.
 Patients and families need to be taught to recognize subtle and atypical symptoms of
hypoglycemia, such as numbness around the mouth and impaired ability to concentrate.

Sudomotor Neuropathy
 The neuropathic condition called sudomotor neuropathy refers to a decrease or absence of
sweating (anhidrosis) of the extremities, with a compensatory increase in upper body
sweating.
 Dryness of the feet increases the risk for the development of foot ulcers.