Symptoms

Signs and symptoms of autonomic neuropathy depend on the nerves affected. They might include:

• Dizziness and fainting when standing, caused by a sudden drop in blood pressure.
• Urinary problems, such as difficulty starting urination, incontinence, difficulty sensing a full bladder and inability to completely empty the bladder, which can lead to urinary tract infections.
• Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men. In women, problems include vaginal dryness, low libido and difficulty reaching orgasm.
• Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn, all due to changes in digestive function.
• Inability to recognize low blood sugar (hypoglycemia), because the warning signals, such as getting shaky, aren't there.
• Sweating abnormalities, such as sweating too much or too little, which affect the ability to regulate body temperature.
• Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.
• Exercise intolerance, which can occur if your heart rate stays the same instead of adjusting to your activity level.

When to see a doctor

Seek medical care promptly if you begin having any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes that's poorly controlled.

If you have type 2 diabetes, the American Diabetes Association recommends annual autonomic neuropathy screening beginning when you receive your diagnosis. For people with type 1 diabetes, the association advises annual screening beginning five years after diagnosis.