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Introduction to the Symptoms of Autonomic Neuropathy
One of the really scary things about autonomic neuropathy is the way it can cut off warning signs to the brain that the body sends out when trouble is brewing. As a result, people with autonomic neuropathy may be well on their way to getting very sick but have no idea anything is wrong.
This article will highlight some of the major complications associated with autonomic neuropathy so you can potentially recognize the problem and see a doctor right away. You'll find:
- Autonomic Neuropathy and Hypoglycemia
Autonomic neuropathy can mask the signs of hypoglycemia, such as trembling and sweating, and can disrupt the body's ability to maintain glucose levels between meals. Learn more about why autonomic neuropathy can be dangerous for those who become hypoglycemic on this page. - Autonomic Neuropathy and the Heart
Most people know the telltale signs of a heart attack -- tightening of the chest, pain in the left arm, and so on. But for people suffering from autonomic neuropathy, these signs can be dulled or not felt at all. Learn about this and other potential problems with the heart associated with diabetes-induced nerve damage on this page. - Autonomic Neuropathy and the Digestive System
Autonomic neuropathy can really do a number on your stomach. Problems range from constipation to diarrhea, gastroparesis to trouble swallowing. Find out more about how autonomic neuropathy can affect the digestive system in this section. - Autonomic Neuropathy and Sweating
One potential problem associated with diabetes-induced nerve damage is anhidrosis, or loss of sweating, in the feet. While this sounds kind of nice, it can actually cause painful dryness and result in profuse sweating in other parts of the body. In this section, you'll learn all about sweating problems related to autonomic neuropathy. - Autonomic Neuropathy and Urinary Problems
Incontinence, urinary tract infections, erectile dysfunction -- the list of urinary problems caused by diabetes-related nerve damage is long. Find out how to recognize these and other urinary-related symptoms in this informative section. - Autonomic Neuropathy and Vision
Night blindness is a common setback that is associated with autonomic neuropathy. This is because the pupils of those suffering from this condition often respond more slowly to changes in light and have a smaller diameter. Check out this section for more information on this and other vision problems. - Proximal Neuropathy
Talk about a pain in the butt! Proximal neuropathy is a condition that actually does cause pain the buttocks...and the thighs and hips, to be exact. It's no laughing matter, however. Those who suffer from it can have trouble climbing stairs or even standing up from a seated position. Learn more about proximal neuropathy on this page. - Focal Neuropathy
Double vision, Bell's palsy, sudden weakness in the ankle -- these and other unusual symptoms are often traced to focal neuropathy, a condition caused by damage to a nerve controlling a specific muscle. Find out about this type of neuropathy here.
Let's start by taking a closer look at autonomic neuropathy and how it affects hypoglycemia on the next page.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Autonomic Neuropathy and Hypoglycemia
While you don't have to have diabetes to develop autonomic neuropathy, one complication is of particular concern to people who have the disease. When a person who doesn't have autonomic neuropathy becomes hypoglycemic, the body releases compounds called catecholamines that cause trembling and a cold sweat. Anyone with diabetes should recognize these symptoms as evidence of low blood sugar, a problem that can be remedied by downing a glucose pill or a sweet snack or beverage.
However, autonomic neuropathy interferes with catecholamines, so diabetes patients who have this form of nerve damage don't develop the familiar trembling and sweating when their glucose plummets. Autonomic neuropathy can disrupt the body's ability to maintain glucose levels between meals. Normally, the pancreas releases the hormone glucagon, which triggers the liver to release glucose into the bloodstream when levels drop. This so-called glucagon response naturally weakens over time in patients with type 1 diabetes. But it's absent altogether if you have autonomic neuropathy.
Check out the next section for potential dangers to the heart caused by autonomic neuropathy.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Autonomic Neuropathy and the Heart
Ischemia is simply the medical term for a loss of blood flow to an organ. When that organ happens to be your heart, the result is very bad news indeed -- a heart attack. Fortunately, heart attacks usually hurt like the dickens, causing chest pain and other symptoms, such as pain or pressure in the left arm and profuse sweating. Recognize these distinctive signs early enough, and you can call 911 for help.
 Orthostatic hypotension can cause your blood pressure to plunge just by standing up. |
But if you have autonomic neuropathy and damaged nerves have blocked pain signals to the brain, you could be sitting around the house doing a crossword puzzle and have no idea that a clot had formed in your coronary artery and your heart is starving for oxygen. This condition is called painless, or silent, ischemia, and it occurs in about five percent of diabetes patients who don't have autonomic neuropathy. If you have diabetes and autonomic neuropathy, your risk rises to 38 percent.
Painless ischemia is just one potential danger of cardiovascular neuropathy, which occurs in 17 percent of patients with type 1 diabetes and 22 percent of type 2 patients. For example, your body naturally makes adjustments to maintain normal blood pressure and heart rate to suit different circumstances. Autonomic neuropathy blocks the nerve signals that make these adjustments.
Orthostatic hypotension is one common result of this signal interference. If you have this condition, simply standing up can cause blood pressure to plunge. You may only feel a bit dizzy or light-headed, though in some cases people faint. If damage occurs to the nerves that control heart rate, your cardiovascular system may stay on overdrive all day instead of revving up and relaxing to suit your body's various needs. These disturbances in blood pressure and heart rate increase the risk for cardiac catastrophe.
Learn more about digestive problems caused by diabetic neuropathy in the next section.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Autonomic Neuropathy and the Digestive System
Autonomic neuropathy can cause just about any gastrointestinal disorder you can think of (as well as several others you would probably rather not think about at all). The longer you have had diabetes and the more trouble you have maintaining tight glucose control, the more likely you are to have digestive problems. Most GI woes are mild and treatable, but some can become serious.
Constipation is the most common complication caused by glucose-induced nerve damage; about 60 percent of diabetes patients have occasional or frequent bouts with this digestive discomfort.
About one in four diabetes patients develop gastroparesis, another problem related to damaged digestive nerves. This condition causes food to empty out of the stomach slowly. Gastroparesis doesn't always cause symptoms, but in serious cases it can result in episodes of lost appetite, bloating, nausea, vomiting, and abdominal pain that can go on for months. Equally concerning, serious dips in blood sugar can occur if you inject insulin to blunt a post-meal surge of glucose, because gastroparesis delays food from reaching your intestines and being absorbed into the blood. There is no extra sugar to process, and the insulin lowers glucose too much, leading to hypoglycemia.
Diarrhea is another digestive woe that plagues about one in five diabetes patients, and it seems to be more common in those with autonomic neuropathy. Normally, the autonomic nervous system ensures that the food you eat has a smooth and gradual trip through the stomach and intestines. But damaged nerves can disrupt the process, leading to loose bowels and the dreaded fecal incontinence (loss of bowel control).
Finally, damage to nerves in the esophagus can cause difficulty swallowing in some patients.
Of course, lots of other things can cause gastrointestinal problems, so if you develop any of these symptoms, your doctor will want to rule out other potential causes. Constipation, for instance, can be caused by diseases such as hypothyroidism or colon cancer, and it can be a side effect of certain medications, such as calcium channel blockers used to treat hypertension.
Find out how autonomic neuropathy can cause under-active or overactive sweat glands on the next page.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- To learn more about how diabetic neuropathy can disupt the digestive system, visit Diabetes and Digestive Problems.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Autonomic Neuropathy and Sweating
Without sweat glands, we would probably have to pant like dogs (which lack sweat glands) to cool down our bodies on hot days and during exercise. The nervous system controls sweat glands, so when damage strikes nerves in the extremities -- one of the most common complications of diabetes -- the result can be feet that don't sweat.
Diabetes-induced nerve damage can cause a similar problem, known as gustatory hyperhidrosis. Anyone who has ever eaten in a Mexican restaurant knows that chomping on a habanero or some other type of hot pepper not only scorches your tongue but can make your brow perspire. Neuropathy can make you break out in a sweat when you eat or drink anything, no matter how bland. No one is sure why, but it may be that previously blunted sweat glands are reawakened by certain food ingredients, though no single dish is known to have the effect consistently in people who have this peculiar condition. For some reason, the glands overcompensate, glistening the skin on the face, neck, and scalp with sweat.
 Autonomic neuropathy can cause gustatory hyperhidrosis, which causes you to sweat whenever you eat or drink. |
One study of 196 diabetes patients found that roughly one-third who had neuropathy suffered from gustatory hyperhidrosis (the condition is also linked to kidney damage). While any kind of excess sweating can be a social nightmare, gustatory hyperhidrosis worries doctors, since it may disrupt a normal, healthy eating plan, which in turn could cause fluctuations in blood sugar and produce bouts of hypoglycemia.
Urinary problems can also arise from autonomic neuropathy. Learn about some of the symptoms on the next page.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Autonomic Neuropathy and Urinary Problems
Diabetes often strikes below the belt, in a manner of speaking. Normally, when the bladder fills up, nerve signals to the brain instruct you to visit the restroom, and the sooner the better. If those nerves become damaged, however, your bladder can fill up and bulge to three times its normal size, but you may never realize it. Eventually, you may become incontinent -- that is, urine will spill out of the bladder, whether you want it to or not. Studies show that people with diabetes are significantly more likely than the general population to develop incontinence.
 Autonomic neuropathy can cause incontinence, erectile dysfuction, and other problems. |
Nerve damage can also weaken the bladder, making it difficult to empty completely during a visit to the powder room. Over time, bacteria may breed in urine left behind in the bladder, leading to a urinary tract infection (UTI). UTIs are no darn fun; they can cause pain while urinating and make you feel like you need to "go" all day and especially at night, among other symptoms. Having diabetes seems to raise the risk for this pesky problem.
For example, a 2002 study found that postmenopausal women with diabetes were more than twice as likely to develop a urinary tract infection as postmenopausal women without diabetes. What's more, women with diabetes tended to develop more serious and painful infections.
Now, let's make our way from the bathroom to the bedroom, because it's time to broach an even more sensitive issue: Your love life and how nerve damage from diabetes can put a damper on it.
Erectile dysfunction is perhaps the most common male sexual disorder caused by diabetes-related nerve damage. In fact, men with diabetes are three times more likely to develop the problem than men who don't have the disease. Estimates vary, but between 20 and 85 percent of male diabetes patients will experience erectile dysfunction, often called simply ED. For an erection to occur, the brain has to communicate with the penis via a network of nerves; damage to those nerves can spoil the fun.
Another problem, called retrograde ejaculation, occurs more often than normal in men with diabetes. When a male ejaculates, the bladder usually closes. If nerve damage disables the muscles that seal the bladder, semen backs into the organ. As a result, the man ejaculates little or no semen. Although retrograde ejaculation is physically harmless for the man, it can cause infertility. It also turns urine cloudy.
Diabetes is an equal opportunity nuisance when it comes to sexual disorders, however. In fact, at least one study involving patients with type 1 diabetes found that sexual problems were more common in women (27 percent) than men (22 percent). In one survey, the most common sex-related complaint among women with diabetes was vaginal dryness, which results from damage to cells lining the vagina that provide lubrication. Lack of lubrication can make intercourse painful. Add side effects from medications you might be taking, plus anxiety or depression about your health, and it's no surprise that women with diabetes often lose interest in sex or have trouble having orgasms, too.
Losing one's eyesight is one of the more frightening complications associated with diabetes. Learn how autonomic neuropathy can cause vision problems on the next page.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- To learn more about how diabetes can disrupt your urinary tract, read Diabetes and Bladder Problems.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Autonomic Neuropathy and Vision
Loss of vision is one of the most ominous threats people with diabetes face (see Diabetes and Eye Problems). However, damage to the autonomic nervous system causes a specific vision problem in people with diabetes.
The problem is your pupils, the openings in the irises that allow light into the eye. In the dark, pupils dilate to allow more light in. If you have autonomic neuropathy, your pupils may respond more slowly to changes in light and have a smaller diameter. In some cases, the pupils of a diabetes patient are so small and slow that they develop night blindness, making driving after dark risky.
 Night blindness can be a symptom of autonomic neuropathy. |
Check out the next section to find out how autonomic neuropathy can affect the buttocks, hips, and thighs.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Proximal Neuropathy
If you have read this far and think diabetic neuropathy can be a big pain in the butt, you're right -- literally. Proximal neuropathy causes discomfort in the buttocks, hips, and thighs. Pain may subside after a few months, but it's often followed by weakness in the legs that can make it difficult to stand from a sitting or squatting position or to climb stairs. Pain and disability usually occur on one side of the body.
Proximal neuropathy goes by several other names, including lumbosacral plexus neuropathy, femoral neuropathy, and diabetic amyotrophy. It's most common in type 2 diabetes patients and usually occurs after age 50.
Learn more about the painful ramifications of focal neuropathy on the next page.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Focal Neuropathy
When you focus on something, your attention zeroes in on a specific item. Focal neuropathy is damage that occurs to a nerve controlling a specific muscle, often resulting in severe pain. Some of the symptoms of focal neuropathy include:
 Focal neuropathy can cause severe pain in the lower back. |
- double vision or difficulty focusing your eyes
- an ache behind one eye
- paralysis or drooping of one cheek (Bell's palsy)
- severe pain in the lower back or pelvis
- pain in the front of a thigh or in the chest, stomach, or side
- pain on the outer shin or inner foot
- sudden weakness of the ankle, known as "foot drop"
- chest or abdominal pain that mimics a heart attack or attack of appendicitis
Focal neuropathy usually afflicts older patients. It flares up suddenly but seems to fade on its own after a few weeks or months.
A related problem, called entrapment syndrome, occurs when nerves become compressed. The wrists are a common location for entrapment, which is well-known to anyone who has developed carpal tunnel syndrome from using a keyboard or computer mouse for an extended period. (Bones in the wrist called carpals form a tunnellike structure; repetitive motions cause tendons in the wrist to swell, compressing nerves.) As you can see, the various symptoms of autonomic neuropathy can affect almost every part of your body. Learn about the symptoms in this article, and report any signs to your doctor to ensure you stay healthy for a long, long time.
For more information on diabetes and its related conditions, try the following links:
- Diabetic Neuropathy is a complex injury that should not be left undiagnosed. Learn more about it in this informative article.
- Damage to the eyes is a common complication associated with diabetes. Find out more on our Diabetes and Eye Problems page.
- Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
- To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
Timothy Gower is a freelance writer and the author of several books. His work has appeared in many magazines and newspapers, including Prevention, Health, Reader's Digest, Better Homes and Gardens, Men's Health, Esquire, Fortune, The New York Times, and The Los Angeles Times.
ABOUT THE CONSULTANTS:
Dana Armstrong, R.D., C.D.E., received her degree in nutrition and dietetics from the University of California, Davis, and completed her dietetic internship at the University of Nebraska Medical Center in Omaha. In private practice for 21 years, she has developed educational programs that have benefited more than 5,000 patients with diabetes. She is the cofounder and program director of the Diabetes Care Center in Salinas, California..
Allen Bennett King, M.D., F.A.C.P., F.A.C.E., C.D.E., received his degrees and training at the University of California, Berkeley; Creighton University Medical School; the University of Colorado Medical Center; and Stanford University Medical Center. He is the author of more than 50 papers in medical science and speaks nationally on new advances in diabetes.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.