assessment of autonomic neuropathy in diabetic mellitus

What is the significance of autonomic neuropathy in diabetes mellitus ?how can it be assessed?

Autonomic neuropathy is associated with hemodynamic lability  particularly in change in position and initiation of mechanical ventilation. Diabetic patients with autonomic neuropathy are at increased risk for intraoperative hypotension and perioperative cardiorespiratory arrest. There may be an exaggerated pressor response to tracheal intubation. Autonomic neuropathy predisposes to intraoperative hypothermia.

Diabetic patients may have delayed gastric emptying as a result of diabetic autonomic neuropathy, and therefore an increased risk of pulmonary aspiration of gastric contents.

Assessment of autonomic neuropathy :

Cardiovascular

·        Resting tachycardia

·        Exercise intolerance

·        Orthostatic hypotension

·        Silent myocardial ischaemia

Gastrointestinal

·        Oesophageal  dysphagia

·        Gastroparesis

·        Constipation

·        Diarhoea

·        Faecal incontinence

Genitourinary

·        Neurogenic bladder

·        Erectile dysfunction

·        Retrograde ejaculation

·        Female sexual dysfunction

Metabolic

·        Hypoglycaemic unawareness

Sudomotor

·        Anhidrosis

·        Heat intolerance

·        Gustatory sweating

·        Dry skin

Pupillary

·        Pupillomotor function impairment

·        Argyll-robertson pupil

Tests for diabetic autonomic neuropathy

·        Early stage: abnormality of heart rate response during deep breathing alone

·        Intermediate: an abnormality of valsalva response

·        Late stage: the presence of postural hypotension