Introduction

Common features of diabetic autonomic neuropathy include:

• hypoglycaemia unawareness (see Hypoglycaemia unawareness)
• erectile dysfunction
• orthostatic hypotension
• diabetic gastroparesis
• diarrhoea
• bladder atony with urinary retention (and sometimes overflow) and asymptomatic or symptomatic urinary tract infection
• cardiac autonomic neuropathy.

Screening for symptoms of autonomic neuropathy is important, starting at diagnosis for patients with type 2 diabetes, and 2 to 5 years after the diagnosis of type 1 diabetes (after age 11 years).

No specific treatments for diabetic autonomic neuropathy are available—management is mainly aimed at relieving symptoms. Achieving and maintaining tight glycaemic targets can help prevent an exacerbation.