Diabetic Autonomic Neuropathy – Keep the car moving  

By Jacob Panici, DPM

First let us agree on what we are talking about. Autonomic neuropathy has nothing to do with driving your car despite the title.   Rather, ‘auto’ refers to the fact that your body performs many different functions without conscious thought or direction. You think about picking up an object, taking a bite of dinner or walking from here to there; you do not think about sweating, digesting food, or making your heart beat.

An Automatic Nervous System

The many functions your body performs without you thinking about it are automatic. These ‘automatic’ nerves are known as the autonomic nervous system.  Much like the nerves involved in peripheral neuropathy, this system is also at risk when blood sugars remain high.  Much like your sensory nerves can be damaged and function abnormally, the autonomic nervous system can also be affected.   As there are many functions your body maintains without you thinking about it, it is important to understand what is at risk.

What comprises the autonomic nervous system?

The autonomic nervous system is involved throughout body but your endocrine system, your digestive system, and your heart are most critical.   

• Diabetes is often diagnosed with high blood sugars.  Your body’s inability to control when sugars are too high or too low can worsen the situation. Low sugars, or hypoglycemic unawareness, can actually result in severe organ damage.   It is critical that you maintain proper blood sugars with regular testing in order to prevent low sugars and their side effects.
• Your digestive system can lose it ability to regulate movement through the organs.  Swallowing can become challenging or stomach contents will not transfer to your intestines.  This ‘gastroparesis’ can lead to constipation, diarrhea, or both. Similarly, the bladder can malfunction leading to inability to release, lack of control, or infections.
• The heart and lungs are also at risk of injury with autonomic neuropathy.  The system of moving blood with nutrients and oxygen is dependent upon a high degree of regulation between the lungs, digestive system, and heart. If the relay of information to your heart and lungs is inaccurate, you can experience rapid heart rate without increased activity or a normal heart rate when your body would normally increase to meet demands.  This dysregulation can lead to fainting or dizziness. It is critical for you to seek medical treatment if you experience these types of symptoms.

What happens when the automatic system malfunctions?

One of the ‘simple’ automatic functions your body performs is the control of the sweat and oil glands that moisturize your skin. The diabetic peripheral neuropathy discussed in our previous article can exhibit this change.  As they body loses its ability to release the proper oils and moisturizers the skin becomes less pliable, very dry and can easily crack.  A water based lotion should be used to address this.  It is important to moisturize your feet once or twice daily when living with diabetes.  Use a quarter sized amount of lotion and rub into the skin until completely absorbed. Be cautious not to leave lotion between the toes where it can cause problems.   Including this step with your daily inspection can keep your skin in its best condition and prevent sores and other complications.

Keeping your blood sugars as close to normal with good food choices and daily activity can prevent worsening of diabetes and the nerve damage that can occur.

(Editors note:  I recommend ammonium lactate 12% to many of my high risk and diabetic patients with dry skin.  I will place a link below.)