Nerve Damage Beyond the Hands and Feet
By Hope Warshaw
Managing diabetes effectively can help protect you from autonomic neuropathy, a type of nerve damage that affects digestion, breathing, and blood pressure.
If you live with diabetes, particularly diabetes with chronically high A1C levels, you are at risk for nerve damage, or neuropathy. There are two main categories of neuropathy that are common diabetes-related complications. One is peripheral neuropathy, or nerve damage to the hands and feet. The other is autonomic neuropathy, or damage to the nervous system that controls involuntary processes.
Learn more about autonomic neuropathy as a diabetes complication, as well as risk factors, prevention measures, screening methods, and treatment options to manage the condition as recommended by the ADA’s most current standards of care.
What is autonomic neuropathy, and how does it relate to diabetes?
Autonomic neuropathy is a group of symptoms that occur when there is nerve damage to the nerves that manage automatic, involuntary body functions. Chronically high blood glucose levels can damage the small blood vessels that transport blood to the nerves, leading to disrupted signals between the brain and the nervous system. Autonomic neuropathy affects the nerves in your autonomic nervous system, or the part of your nervous system that controls muscles in the body’s organs, such as the heart, blood vessels, lungs, gastrointestinal and urinary tract, sex organs, and sweat glands. It’s estimated that around a third of people with diabetes will experience autonomic neuropathy.
Symptoms of diabetic autonomic neuropathy
Autonomic neuropathy encompasses a diverse group of signs and symptoms. These include dizziness, dry eyes, mouth or skin; and rapidly feeling full after eating (gastroparesis). It can also cause a wide array of health problems.
Depending on which of your body’s automatic functions are affected, symptoms of this type of neuropathy may include the following:
Heart-related issues
Heart-related issues can include any of the following symptoms:
- A racing heart while at rest (tachycardia)
- Dizziness or lightheadedness and fainting when going from a sitting or lying down position to standing up due to low blood pressure (orthostatic hypotension/postural hypotension)
- Increased or decreased amount of sweating
Gastrointestinal issues
Issues may involve any portion of the gastrointestinal tract from the esophagus all the way down to the bowels, and may include gastroparesis, or slowed emptying of the stomach that can cause early fullness, bloating, nausea and vomiting. A telltale sign of gastroparesis is difficult-to-manage glucose levels and upper GI symptoms like abdominal pain, nausea and vomiting with no other cause. The diagnosis can be made by measuring how quickly food empties from the stomach. Other GI problems include constipation, diarrhea, or inability to control bowel movements.
Genital and urinary tract issues
In men, this may include erectile dysfunction, which is the inability to maintain an erection for sexual intercourse. In women, it may include decreased sexual desire and arousal, pain during intercourse and inadequate lubrication. In both men and women, bladder dysfunction can include incontinence, urgency, and frequency.
Prevention of autonomic neuropathy
As is true for the prevention or delay of most diabetes-related problems, there are actions to take daily. Keeping your glucose, blood pressure and lipids at safe levels can aid in the prevention of diabetic autonomic neuropathy. You should also get comprehensive screenings as detailed below, and take note of any symptoms that may suggest autonomic nerve damage.
It’s important to recognize the symptoms of autonomic neuropathies, and to report any signs of a nerve-related problem to your healthcare provider. If you have a problem that requires further testing and evaluation, be proactive by putting together an action plan with your provider for treatment and follow up.
Risk factors for diabetes-related autonomic neuropathy
Your chance of developing diabetes-related autonomic neuropathy correlates closely with certain factors, such as:
- Chronically high blood glucose levels
- Widely fluctuating glucose levels
- Consistently high blood pressure
- Abnormal levels of blood lipids, like LDL cholesterol and triglycerides
- Having excess weight or obesity
- Advanced-stage chronic kidney disease
- Smoking
How often to screen for diabetic autonomic neuropathy
Get an annual assessment for signs and symptoms of autonomic neuropathy if you have type 2 diabetes or have had type 1 diabetes for 5 years or more and have other complications, particularly kidney disease and peripheral neuropathy. These routine checks are recommended in the ADA’s most recent Standards of Care supplement on retinopathy, neuropathy, and foot care.
A healthy lifestyle as prevention for diabetic autonomic neuropathy
To avoid autonomic neuropathy as a potential complication, put a plan in place to practice regular diabetes self-care. In addition to getting and keeping glucose levels, lipids, and blood pressure in a desired target range, try to live the healthiest possible lifestyle that you can. This includes getting regular physical activity, choosing and eating healthy foods, maintaining healthy eating habits, quitting or not smoking, consuming no more than one alcoholic drink per day for women and two for men, and taking medications as prescribed.
Treatment for diabetic autonomic neuropathy symptoms
There are few specific treatments for diabetes-related nerve damage that completely resolve the problem. For this reason, both glucose management as well as early detection and action are key to preventing and slowing the progression of diabetic neuropathy.
Management of an autonomic neuropathy generally focuses on reducing symptoms and improving quality of life but does not remedy nerve damage.
Treatment for heart-related issues
Treatment for heart-related issues focuses on minimizing symptoms through medication and lifestyle changes.
Treatment for gastroparesis
Certain medications may help improve stomach emptying and control nausea and vomiting. Changes to the diet, such as choosing foods that are low in fiber and fat, eating small frequent meals and chewing food thoroughly before swallowing, also help address gastroparesis.
Treatment for sexual dysfunction
Treatment for erectile dysfunction can include use of one of the medications that enables the maintenance of an erection, or a vacuum device or penile prosthesis. For women, over-the-counter lubricants can help address sexual side effects.
Recommendations in this article are aimed at adults with type 1 and type 2 diabetes and exclude children and adolescents as well as pregnant people with diabetes. Discuss your targets with your healthcare providers; recommendations may vary based on a number of personal factors.
About this series
Each year the American Diabetes Association updates its Standards of Medical Care in Diabetes based on current science. We’ve translated key points of the up-to-date Standards into plain English so you know how to stay healthy and minimize diabetes complications.
Other articles in this series:
- Your Guide to the 2023 ADA Standards of Care
- Current Targets for Lipids, Cholesterol, Blood Pressure, Time in Range, and A1C
- How to Take Care of Your Heart With Diabetes
- How to Keep Your Kidneys Healthy When You Have Diabetes
- How to Keep Your Eyes Healthy With Diabetes
- Protecting Your Liver When You Have Diabetes
- How to Avoid Nerve Damage in Your Hands and Feet With Diabetes
