Diabetes is a condition of elevation of blood sugar levels above normal. Over the years diabetes is known to cause damage to the target organs of the body. These are the eyes, kidneys, brain, peripheral blood vessels and nervous system. Complications appear early and are more severe with uncontrolled diabetes. Affliction of the peripheral nervous system is the one known commonly. It is manifested by tingling, numbness and or burning sensation in hands and feet. But involvement of autonomic nervous system (system responsible for involuntary actions like heart beat, intestinal movements, e.t.c.) is more subtle and people are often ignorant about it. Autonomic neuropathy in case of a diabetic may be associated with affection of peripheral nerves or can occur independently. As the intestinal motility becomes deranged, affected person may develop chronic diarrhoea or constipation. Stasis of food in intestines due to constipation leads to overgrowth of bacteria, which leads to recurrent infections and diarrhoea with or without abdominal pain. Absorption of food as well as that of tablets used to control diabetes is also impaired due to reduced intestinal motility. Due to this, the body gets deprived of necessary nutrients over a period of time. The blood glucose levels are deranged leading to sudden low or high levels of glucose. A person starts suffering from low blood pressure, because of affliction of autonomic nervous system. Mostly he or she suffers from postural hypotension. That is the blood pressure falls and becomes very low as one stands up from sitting or lying down position. Because of this it becomes difficult to walk and one tends to feel giddy while standing or walking. Heart rate also tends to be disturbed because of disturbance of autonomic nervous system. This is because heart fails to adjust its rate according to stress, which it does under normal conditions. This also contributes to fainting. Urinary system is also not spared by diabetes. There is difficulty to pass urine leading to retention of urine in extreme cases, as the nervous control over bladder is damaged. Stasis of urine even in small quantities becomes a source for germs to grow causing recurrent urinary tract infections. Symptoms are further aggravated due to high blood glucose levels. Due to infection of the urinary tract, one suffers from increased frequency and urgency of urination. Sexual impotence is the most troublesome and embarrassing problem created due to autonomic neuropathy. Diabetic neuropathy is the most common organic cause for erectile dysfunction in a young man. Alcohol intake and smoking further aggravate these complications caused due to diabetic autonomic neuropathy. Many times, diabetes is diagnosed when a person develops any of these complications. A sufferer may develop one or more than one feature of autonomic neuropathy. Autonomic neuropathy is a problematic condition because the signs are often confused with other conditions presenting with similar features. This is particularly so when the patient has no other complication or sign suggestive of diabetes. Due to delay in diagnosis, problem continues and is increased in magnitude. A high index of suspicion is needed to diagnose diabetes in face of autonomic neuropathy. Unfortunately once autonomic nervous system is damaged there is no medicine to revert it. Drugs like gabba pentin are used but only provide transient relief. Similarly tablets or injections of B.complex given in this condition are only for some relief but are not curative. Avoiding standing for long time and sitting with legs spread in front can reduce postural hypotension. Use of elastic stockings or crepe bandage while standing or walking also helps in minimizing postural hypotension. To prevent such troublesome complications it is imperative that diabetes should be diagnosed at the earliest. Screening all middle aged persons for diabetes is a good strategy. A very good control of diabetes by means of diet restriction and anti diabetic drugs can delay or minimize the development of complications including neuropathy. Avoidance of alcohol and smoking is helpful in reducing the suffering. A known patient of diabetes should not worry about autonomic neuropathy but has to be very cautious to see that it does not develop. The author is a Specialist in Internal Medicine E-mail: rachna212002@yahoo.co.uk
