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Handbook of Diabetes, 4th Ed., Excerpt #16: Diabetic Neuropathy

Autonomic neuropathy

In patients with long-standing diabetes, numerous abnormalities can be demonstrated in organs that receive an autonomic innervation (Figure 17.10). Often, autonomic abnormalities are found in those with distal sensory neuropathies. Symptoms are unusual, occurring mostly in those with poorly controlled type 1 diabetes. Common manifestations are gustatory sweating over the face, induced by eating cheese or other foods, postural hypotension (systolic blood pressure fall > 30 mmHg on standing), blunting of physiological heart rate variations, diarrhea and impotence. Gastroparesis (delayed gastric emptying and vomiting) and bladder dysfunction are rare.
Management of diabetic neuropathy begins with explanation and empathy, the exclusion of other causes of neuropathy (e.g. alcoholism, vitamin B12 deficiency and uremia), and then the institution of tight glycemic control. Both the DCCT and UKPDS trials show that strict glycemic control can decrease the risk of developing neuropathy, as judged by objective measures such as nerve conduction velocity. However, the main complaint of patients with neuropathy is pain, and there is as yet little evidence that improving diabetic control influences the intensity of neuropathic pain (Figure 17.11).

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Rudy Bilous MD, FRCP, Professor of Clinical Medicine, Newcastle University, Honorary Consultant Endocrinologist, South Tees Foundation Trust, Middlesbrough, UK
Richard Donnelly MD, PHD, FRCP, FRACP, Head, School of Graduate Entry Medicine and Health, University of Nottingham, Honorary Consultant Physician, Derby Hospitals NHS Foundation Trust, Derby, UK
A John Wiley & Sons, Ltd., Publication

This edition first published 2010, © 2010 by Rudy Bilous and Richard Donnelly. Previous editions: 1992, 1999, 2004

 

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