Autonomic Neuropathy

Abnormalities of the autonomic function in those with diabetes of long duration are common – clinically significant autonomic neuropathy is less common.

Common abnormalities in diabetes include:
Cardiovascular (eg postural hypotension; resting tachycardia; arrhythmias); gastrointestinal (eg dysphagia, gastroparesis, constipation, diarrhoea); erectile dysfunction (affects 30% of males with diabetes); sudomotor (eg gustatory sweating, nocturnal sweats); vasomotor (eg dependent oedema); eye (eg decreased pupil size, delayed response to light changes); respiratory (bronchconstrictor dysfunction)

In foot the microcirculation control is affected by increased arteriovenous shunting; prominent veins; increased nutritive capillary flow at rest; reduced axon flare response; and impaired postural vasoconstriction.

Investigations:
variability if heart rate
orthostatic blood pressure response

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