II. Background

  1. Subtype of Diabetic Neuropathy
  2. Affects sympathetic, parasympathetic and enteric nerves

III. Epidemiology

  1. Most common in >20 years of poor glycemic control

IV. Cardiovascular Autonomic Neuropathy

  1. Orthostatic Hypotension
  2. Exercise intolerance
  3. Syncope
  4. Prolonged QT interval on Electrocardiogram
  5. Evaluate Heart Rate variability and stress test

V. Gastrointestinal Autonomic Neuropathy

  1. Altered bowel habits (Diarrhea or Constipation)
  2. Gastric atony (Dysphagia, bloating, Nausea)
  3. Fecal Incontinence

VI. Genitourinary Autonomic Dysfunction

VII. Miscellaneous autonomic symptoms

  1. Unaware of hypoglycemic episodes
  2. Abnormal pupil function
  3. Sudomotor Neuropathy (Sweat Gland dysfunction)
    1. Dry, pruritic skin
      1. Extremity Hair Loss

VIII. Differential Diagnosis

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