Diabetes: Autonomic neurop signs

Clinical Signs of Diabetic Autonomic Neuropathy:

• Hypertension
• Painless myocardial ischemia
• Orthostatic hypotension
• Lack of heart rate variability (normal HR variability during voluntary deep breathing of 6 breaths/min is >10 beats/min)
• Reduced heart rate response to atropine and propranolol
• Resting tachycardia
• Early satiety
• Neurogenic bladder
• Lack of sweating
• Impotence

Diabetic patients with hypertension have a 50% likelihood of coexisting diabetic autonomic neuropathy. Reflex dysfunction of the autonomic nervous system may be increased by old age, diabetes > than 10 years, CAD, or -adrenergic blockade. Diabetic autonomic neuropathy may limit the heart’s ability to compensate for intravascular volume changes and may predispose patients to cardiovascular instability (eg, postinduction hypotension) and even sudden cardiac death, the incidence of which may be increased by the concomitant use of ACE-inhibitors or ARBs. There may be an exaggerated pressor response to tracheal intubation. They are also predisposed to intraoperative hypothermia. Furthermore, autonomic dysfunction contributes to delayed gastric emptying, putting patients at risk for aspiration of gastric contents. Premedication with an antacid and metoclopramide would be particularly prudent in an obese diabetic patient with signs of cardiac autonomic dysfunction. However, autonomic dysfunction can affect the gastrointestinal tract without any signs of cardiac involvement.