Diabetic autonomic neuropathy is a common complication of diabetes. It occurs when high levels of sugar and fat in the blood damage the nerves that control the internal organs.

Diabetes is a metabolic disorder that affects the body’s ability to either produce or effectively use insulin. This can result in problems managing blood sugar levels and may lead to high blood glucose levels.

According to a 2020 National Diabetes Statistics Report, about 34.2 million people in the United States are living with diagnosed or undiagnosed diabetes.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that diabetes-related neuropathy occurs when high blood sugar and fat levels damage the nerves that control internal organs. This can affect many body systems, such as:

  • heart rate
  • blood pressure
  • digestive system
  • bladder
  • sex organs
  • sweat glands
  • eyes

This damage can also lead to hypoglycemia unawareness. Hypoglycemia unawareness is when a person does not notice the symptoms of low blood sugar.

Read on to learn why autonomic neuropathy occurs in diabetes, including its diagnosis, symptoms, and treatments.

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Autonomic neuropathy refers to nerve damage that affects the autonomic nervous system. These nerves control the automatic processes of internal organs, such as the bladder, intestinal tract, sex organs, and urinary tract.

A person’s symptoms may vary widely depending on the affected organ.

According to 2018 research, diabetes is the most common cause of neuropathy in the United States.

Over time, high glucose and high levels of fats in the blood from diabetes can damage nerves and the small blood vessels that nourish the nerves, leading to autonomic neuropathy.

Damage to the nerves that control internal processes or organ functions may affect the nervous response to a change in stress, physical activity, and body position.

According to the NIDDK, symptoms depend on the affected organ.

Autonomic neuropathy is a progressive condition that develops over many years. Some people may not notice symptoms of mild nerve damage for a long time. In some people, severe pain begins suddenly.

Digestive system

Symptoms of autonomic neuropathy affecting the digestive system include:

Urinary tract

Symptoms of autonomic neuropathy affecting the nerves of the bladder include:

Sex organs

Symptoms of autonomic neuropathy affecting the reproductive organs include:

Heart and blood vessels

Symptoms of autonomic neuropathy affecting the heart and blood vessels include:

Sweat glands

Symptoms of autonomic neuropathy affecting the sweat glands include:


Symptoms of autonomic neuropathy affecting the eyes include:

  • difficulty driving at night
  • slow pupil adjustment from dark to light

Other symptoms

A significant and potential sign of autonomic neuropathy is hypoglycemic unawareness. This is when a person does not feel the effects of low blood sugar levels.

Early symptoms of low blood glucose can include:

  • dizziness
  • hunger
  • irritability
  • nervousness

To diagnose diabetic autonomic neuropathy, a doctor may perform a physical examination to check for:

  • ankle reflexes
  • loss of sensation
  • changes in skin color
  • changes in skin texture

To rule out diabetic autonomic neuropathy, the doctor may order additional testing depending on a person’s symptoms. These tests can include:

  • urine tests to assess bladder function
  • bladder ultrasound to examine the bladder structure and function
  • abdominal X-rays to evaluate the digestive tract
  • gastric emptying test to assess gastric motility and muscle activity
  • blood pressure test to check blood pressure and heart rate
  • tilt-table test to measure blood pressure when changing posture
  • thermoregulatory test to look at sweat patterns during temperature changes

Diabetic autonomic neuropathy is a progressive condition. It may require multiple treatment approaches.

Treatment aims to prevent progression and improve symptoms. Which treatment a doctor prescribes depends on a person’s symptoms.

Digestive and gastrointestinal treatments include:

  • taking laxatives for constipation
  • taking prescription medication to improve digestion
  • increasing fiber-rich foods and fluid intake to aid bowel movement
  • taking tricyclic antidepressants for gastrointestinal discomfort

Bladder and urinary tract treatments include:

  • improving fluid intake
  • taking a prescription antibiotic for bladder infection
  • scheduling drinking and urination to improve bladder function
  • taking prescription medications to treat urinary incontinence

Sexual dysfunction treatments include:

  • taking prescription medications to improve erection
  • using a vacuum pump to increase blood flow to the penis
  • applying lubricants to relieve vaginal dryness

Heart and blood pressure treatments include:

  • getting more physical activity
  • increasing salt in the diet to improve blood pressure if it drops too low while standing up
  • increasing fluid intake
  • sitting or standing slowly to prevent lightheadedness or fainting
  • raising the head of the bed or wearing compression stockings to improve blood flow

Sweat gland treatments include:

  • avoiding too much heat or humidity
  • using a prescription antiperspirant or taking a medication to decrease sweating
  • getting surgery to cut the nerves in the sweat glands or to remove the sweat glands

Diabetic autonomic neuropathy is a common complication of diabetes. It can cause damage to the nerves that control the internal organs.

As such, autonomic neuropathy can lead to issues with many body systems.

Diabetic autonomic neuropathy can occur due to high levels of glucose and fats in the blood, damaging and obstructing blood supply to the nerves.

Diagnosis includes a range of scans and tests, including ultrasound, blood test, and urine tests. Treatment involves several medication and lifestyle modifications to manage pain and improve nerve signaling.