Autonomic Neuropathy

Autonomic Neuropathy (AN) is more common among diabetics, and is especially common after 25 years of diabetes. Here are the more common symptoms from the Mayo Clinic:

" Dizziness and fainting upon standing caused by a drop in blood pressure.

Urinary problems, including difficulty starting urination, urinary
incontinence and an inability to completely empty your bladder, which can lead to urinary tract infections.

Sexual difficulties, including problems achieving or maintaining an
erection (erectile dysfunction) or ejaculation problems in men, and
vaginal dryness and difficulties with arousal and orgasm in women.

Difficulty digesting food, due to abnormal digestive function and slow
emptying of the stomach (gastroparesis). This can cause a feeling of
fullness after eating little, loss of appetite, diarrhea,
constipation, abdominal bloating, nausea, vomiting, difficulty
swallowing and heartburn.

Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature.

Sluggish pupil reaction, making it difficult to adjust from light to
dark and causing problems with driving at night.

Exercise intolerance, which may occur if your heart rate remains
unchanged instead of appropriately increasing and decreasing in
response to your activity level."

My neurologist diagnosed my AN in 2010 after I had mentioned extreme dizziness in the AM, and my occasionally falling down. My BP was dropping as much as 40 points when standing up in the morning. Cutting my BP med to half doses has helped, but my BP is still irregular in the morning. I have four of the seven symptoms listed, and they are gradually becoming more pronounced. Gastroparesis is one of the symptoms, but I do not have that problem at the present time. I hope I never do.

Do you have AN, or do you think you do?

Richard - I'm T1D + 31 years. I was diagnosed with gastroparesis (GP) in 2012. I've also experience a slight loss of balance if I need to look up to my sailboat masthead without steadying myself first.

Once I received my GP diagnosis I redoubled my efforts at blood glucose control with significant success. Last January, I started to mix a few tablespoons of potato starch, a source of resistant starch, with water and drink at bedtime. That has mitigated the GP symptoms (I'll leave that to your imagination!) markedly.

One quirky symptom of GP is that I experience something know as "gustatory sweating." I will break out into slight sweat after eating. I often take my jacket and hat off if I'm eating out once the meal ends.

I find that when I look at people in a room with bright daylight in the background, then their faces appear dark to me. I attributed that to developing cataracts. Oh, the joy of aging!

I'm sorry you've experienced these symptoms. You've done so well for so long. I hope that things are manageable for you!

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Hi Terry, have you talked to your endo about this? Maybe you have AN and have not been diagnosed. The best thing though, is to treat each individual symptom. That seems to be what you are doing.

I am doing very well with with digestion, but I have all the other symptoms to some degree, but none of them are so bad now. I will continue my good health despite the minor problems.

My endo is aware of my gastroparesis diagnosis but I haven't mentioned these other symptoms. I assume since I have GP then that means I have AN.

I don't expect much from my endo regarding any response to these other possible autonomic neuropathy symptoms. They aren't strong symptoms and do not limit me in any significant way. Maybe I should give her the opportunity to help if there's something effective she could do. I can be pessimistic regarding help from doctors.

Did you know that hypoglycemic unawareness is also AN? It goes by the longer name of hypoglycemia awareness autonomic failure or HAAF in the medical literature.

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I have been type 1 for 25 years and I have had symptoms from all the above categories (but not ALL the symptoms in each category)for nearly 8 years now; but I have not been officially diagnosed with AN. The symptoms fluctuate with my blood sugar levels. When I am maintaining good BG, the symptoms lessen. But when I am running high for more than a couple days straight, the symptoms begin to become more pronounced.

I did not know about HAAF. Thanks! I do have hypo unawareness rather frequently.

Hi Tamara, when my BG bounces around a lot most of my AN symptoms are definitely more noticeable.

I was diagnosed with type 2 16 years ago and have managed fairly well with a combination of daily activity (2 hours of daily walking) and dietary management (mostly through low GI carbs and unprocessed foods). However, in the last year I've experienced a couple of issues that my doctor has been at a loss to explain and that I suspect may be a result of my diabetes despite constantly encouraging Hba1c levels - below the 7.0 mark.
One has been several (8) episodes where I was out walking and suddenly found myself falling down quite unexpectadly and without losing conciousness. The other has been a quite severe pain in my right calf that has responded favorably to treatment with a medication aimed at the symptoms of diabetic neuropatny. Can't remember the name of that medication offhand but it starts with the letter N and is quite common I understand.
I suppose that what I am wondering about is whether others have experienced the onset of neuropathy or other longterm side effects of diabetes, despite having their diabetes under tight control? As a sidenote, I recently had a checkup with an opthamologist who did not find anything wrong with my eyesight.

Hi Richard! :)

Thanks for bringing this topic up. I've had Diabetes for 53 years this month and I have some of the symptoms also. I'm particularly interested in the regulation of body temperature since mine is usually lower than normal. I didn't know this may be caused by Diabetes. Also Hypo unawareness. It should be on the list too. Thank you for mentioning HAAF Terry.

Terrie, if you read the link I posted, there are several other side effects of AN that are not included in my list. You are right, hypo unawareness is one of them, and another is tinnitus. I have had ringing in my ears for a long time. Now I feel I know the cause of that. I have nerve damage in my ears, and I am wearing hearing aids. That may also be caused by AN.

My Type 1 began in 1945, so tight control could not be measured since there were no meters (until mid 1980s) and no basal/bolus insulins (mid 1990s). My neuropathy in my feet began about 10 years ago. In the last two years I have had pain in my lower legs, primarily in my calves. This may be neuropathy. My eyes, kidneys and heart are in good shape.

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Correction: HAAF actually stands for Hypoglycemia Associated Autonomic Failure.

Hi Richard,
25+ year T2 and just got diagnosed with AN after three years of pushing for answers.i have all but two of the symptoms and life has certainly been difficult not knowing what’s been going on. I’m glad to have an answer and a caring neurologist who is listening to me. Now on to managing the symptoms. My main concern is to control my sugars. Just started Ozempic with good results so far so I am very hopeful. I’m eager to learn from others here. Linda


@Vtfishgirl1, thanks for that post. I have recently read about another person who praised Ozempic.

So far so good!!!

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Type one 44 years. Had GP and Tachycardia or resting heatrate of 100-125 bpm, diagnosed by Dr Richard Bernstein as Autonomic Neuropathy from damage to the vagus nerve. Tachycardia began at about 25 years of age (22 yrs of diabetes at that time) gastroparesis took nearly 35 years. GP has corrected itself (also diminishing peripheral neuropathy of the feet a) in addition to clearing of iron oxide from the legs, all thanks to keeping BG between 4.2 mmol and 6.1 mmol round theclock.

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