Diabetes is a condition of elevation of blood sugar levels above normal. Over the years diabetes is known to cause damage to the target organs of the body. These are eyes, kidneys, brain, peripheral blood vessels and nervous system. Complications appear early and are more if not controlled. Affliction of the peripheral nervous system is well known, which is manifested by tingling, numbness and or burning sensation in hands and feet. But involvement of autonomic nervous system (system responsible for involuntary functions like heart beat, intestinal movements, among others) is more subtle and less known. This may be associated with other diabetic complications or can occur independently. As the intestinal motility is affected, a person may develop chronic diarrhea. Stasis of food in intestines due to constipation leads to overgrowth of bacteria, which results into recurrent infections and diarrhea with or without abdominal pain. Absorption of food as well as that of anti-diabetic medication is impaired due to reduced intestinal motility. As a result, the body gets deprived of necessary nutrients over a period of time. Blood glucose levels are deranged leading to sudden low or high levels. A person starts suffering from low blood pressure, because of affliction of autonomic nervous system. The blood pressure falls and becomes very low as one stands up from sitting or lying down position. Because of this, one tends to feel giddy while standing or walking. Heart rate also tends to be disturbed because of disturbance of autonomic nervous system. This is because heart fails to adjust its rate according to the stress. This also contributes to fainting. Urinary system is also affected. There is difficult to pass urine leading to retention in extreme cases, as the nervous control over bladder is damaged. Stasis of urine even in small quantities becomes a source for germs to grow causing recurrent urinary tract infections. Infection is further aggravated due to high blood glucose levels. Due to infection of the urinary tract, one suffers from increased frequency of urination. Impotence is the most troublesome problem in autonomic neuropathy. Diabetic neuropathy is the most common organic cause for erectile dysfunction in men. Alcohol intake and smoking further aggravate these complications caused due to diabetic autonomic neuropathy. Many times, diabetes is diagnosed when a person develops any of these complications. A sufferer may develop one or more features of autonomic neuropathy. A high index of suspicion is needed to diagnose diabetes in face of autonomic neuropathy. Unfortunately once autonomic nervous system is damaged there is no medicine to revert it. Drugs such as gabba pentin, B Complex, among others, are used but only provide transient relief. Avoiding standing for long time and sitting with legs spread in front can reduce postural hypotension. Use of elastic stockings or crepe bandage while standing or walking also helps in minimising postural hypotension. To prevent such troublesome complications it is imperative that diabetes should be diagnosed at the earliest. Screening all middle aged persons for diabetes is a good strategy. A good control of diabetes by means of diet restriction and anti diabetic drugs can delay or minimise the development of complications including neuropathy. Avoidance of alcohol and smoking is helpful in reducing the suffering. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital
