Related Subjects: |Metabolic acidosis |Type 1 DM | Type 2 DM | Diabetes in Pregnancy | HbA1c | Diabetic Ketoacidosis (DKA) Adults | Hyperglycaemic Hyperosmolar State (HHS) | Diabetic Nephropathy | Diabetic Retinopathy | Diabetic Neuropathy | Diabetic Amyotrophy | Maturity Onset Diabetes of the Young (MODY) | Diabetes: Complications
About
- May affect all organs
Aetiology
- Damage to long nerves e.g. vagus over time
Clinical
- CVS: orthostatic hypotension, syncope, exercise intolerance
- GI: Impaired gastric emptying, Nausea, vomiting, Episodic diarrhoea, Postprandial hypotension
- GU: Bladdery dysfunction, incontinence
- Skin: Poor sweating, warm, dry, hairless skin
- Charcot's joints
Differentials
- Peripheral: Alcohol
- Autonomic:Amyloid, Hereditary
- Immune mediated
Investigations
- Nerve condcution studies may be indicated
- Glucose, U&E, HbA1c
- Assess gastric emptying
- Cardiovascular assessment
Management
- Good diabetic control
- Monofilaments. The monofilament is applied gently until slightly deformed at five points on each foot. Callus should be avoided as sensation is reduced. If the patient feels fewer than 8 out of 10 touches, the risk of foot ulceration is increased 5–10-fold.
- Review drugs. Look for an underlying cause
- Consider Salt loading, Fludrocortisone and Midodrine for hypotension