Diabetic Visceral Neuropathy
The visceral neuropathies or autonomic neuropathies cause
various manifestations, depending on the area of the autonomic nervous
system involved. These neuropathies may include the following symptoms.
• Sweating dysfunction, with an absence of sweating on the hands and feet
and increased sweating on the face or trunk.
• Abnormal papillary function, most commonly seen as constricted pupils that
dilate slowly in the dark.
• Cardiovascular dysfunction, resulting in such abnormalities as a fixed
cardiac rate that does not change with exercise, postural hypotension, and a
failure to increase cardiac output or vascular tone with exercise.
• Gastrointestinal dysfunction, with changes in upper gastrointestinal
motility resulting in dysphagia, anorexia, heartburn, nausea, and vomiting
and altered blood glucose control. Constipation is one of the most common
gastrointestinal symptoms associated with diabetes, possibly a result of
hypomotility of the bowel. Diabetic diarrhea is not as common, but it does
occur and is often associated with fecal incontinence during sleep due to a
defect in internal sphincter function.
• Genitourinary dysfunction, resulting in changes in bladder function and
sexual function. Bladder function changes include an inability to empty the
bladder completely, loss of sensation of bladder fullness, and an increased
risk of urinary tract infections. Sexual dysfunctions in men include
ejaculatory changes and impotence. Sexual dysfunctions in women include
changes in arousal patterns, vaginal lubrication and orgasm. Alterations in
sexual function in people with diabetes are the result of both neurologic
and vascular changes.
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