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).
For more information and to purchase this book, just follow this link:
This edition first published 2010, © 2010 by Rudy Bilous and Richard Donnelly. Previous editions: 1992, 1999, 2004
Note: The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the authors make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organisation or website is referred to in this work as a citation and/or a potential source of further information does not mean that the authors or the publisher endorse the information the organisation or website may provide or recommendations it may make. Further, readers should be aware that Internet websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the authors shall be liable for any damages arising herefrom.