Treatment:

Treatment is supportive and may need to be long-term. Several treatments may be attempted before a successful one is found.

Various strategies may be used to reduce symptoms in the feet, legs, and arms. These include:

• Florinef and salt tablets to increase fluid volume in blood vessels
• Fludrocortisone or similar medications to reduce postural hypotension
• Medications to help with salt and fluid retention
• Proamatine to prevent a drop in blood pressure when standing
• Sleeping with the head raised
• Use of elastic stockings

Treatments for reduced gastric motility include:

• Medications that increase gastric motility (such as Reglan)
• Sleeping with the head raised
• Small, frequent meals

Diarrhea, constipation, bladder problems, and other symptoms are treated as appropriate. These symptoms may respond poorly to treatment. Drugs that block bladder contractions may be used to help with urinary control problems.

Phosphodiesterase type 5 (PDE-5) drugs, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are safe and effective for treating impotence in patients with diabetes.

Expectations (prognosis):

The outcome varies. If the cause can be found and treated, there is a chance that the nerves may repair or regenerate. The symptoms may improve with treatment, or they may continue or get worse, even with treatment.

Most symptoms of autonomic neuropathy are uncomfortable, but they are rarely life-threatening.

Complications:

• Fluid or electrolyte imbalance such as low blood potassium (if excessive vomiting or diarrhea)
• Injuries from falls (with postural dizziness)
• Kidney failure (from urine backup)
• Malnutrition
• Psychological/social effects of impotence

Calling your health care provider:

Call for an appointment with your health care provider if you have symptoms of autonomic neuropathy. Early symptoms might include:

• Becoming faint or light-headed when standing
• Changes in bowel, bladder, or sexual function
• Unexplained nausea and vomiting when eating

Early diagnosis and treatment increases the likelihood of controlling symptoms.