Diabetic Autonomic Neuropathy - Aetna InteliHealth: Featuring Harvard Medical School's Consumer Health Information

Diabetes can cause damage to the family of nerves that is known as the autonomic nervous system. Autonomic nerves regulate body functions that are not controlled consciously. These include:

Digestion
Emptying of the bladder
Heart rate and blood pressure
The flow of blood
Sexual function

Diabetes is not the only cause of autonomic neuropathy. Other causes include:

Inherited nerve disorders
Toxins
A lack of certain nutrients
Autoimmune diseases

Sometimes the cause is not identified.

Symptoms vary, depending on which nerves are affected.

Stomach and bowel problems — Autonomic nerves control the movements of the stomach and intestines. These organs normally push food forward with squeezing movements. Nerve damage can make these movements less effective or less predictable. This can cause nausea, diarrhea or constipation. Problems with swallowing or bowel control also can occur. Sometimes, the stomach is slow to empty. This is a diabetes-related condition called gastroparesis.

Dizziness when standing — When you change position, autonomic nerves help to keep your blood pressure steady. As you stand up, gravity tends to make blood build up in your legs. When your body is working right, your blood vessels tighten to keep blood flowing. When the autonomic system is injured, this doesn't always happen. As a result, you can have low blood pressure when you are standing. You may feel lightheaded.

Poor endurance when exercising — Nerve damage can limit your heart's ability to increase blood flow during exercise. You may feel fatigued quickly.

Sexual function problems — The most common symptom from autonomic nerve damage is male impotence. One study found that nearly half of men with type 1 diabetes experience impotence by age 43. This is also called erectile dysfunction. Some women with diabetes also say they feel less sexual response. Some report dryness in the vagina. These problems can be a result of autonomic nerve damage. Diabetes also can cause artery damage. This often contributes to the problem of impotence.

Poor bladder emptying — Nerve injury can allow the bladder to overfill. This may result in urinary tract infections. Urine also may leak.

Autonomic neuropathy usually develops slowly. It typically will appear years after diabetes has been diagnosed. Nerve damage usually can't be reversed.

Fortunately, you can prevent autonomic neuropathy, or at least delay it. The best way to do this is to keep good control of your blood sugar. Smoking makes neuropathy worse, so smokers should stop. Finally, doctors recommend eating a balanced diet and having no more than one to two drinks of alcohol per day.

You can get treatment to reduce the symptoms of diabetic autonomic neuropathy. Doctors can't restore nerve function. But medicines and strategies can be used to compensate for the loss.

For example, let's say you get dizzy when you stand. You may find that it helps to flex your ankles and calf muscles before standing up. You also can try wearing support stockings, increasing the salt in your diet, and taking a drug that boosts your blood pressure. Standing up gradually also may help. If you have been lying down, sit for a few minutes. Then stand up slowly.

For erectile dysfunction, multiple treatments are available. Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) are used most often. Medicines may help digestive problems. The drugs may encourage emptying of the stomach and movement of the bowels. Changes in your diet may reduce constipation. If your bladder overfills, you may need to use a schedule for bathroom visits.