What the patient and their family should know.
Your peripheral nervous system can be divided into three general categories:
1. Sensory Nerves deliver to the brain information about the five senses of touch, smell, taste, hearing and sight.
2. Motor Nerves voluntarily control our muscle movements.
3. Autonomic Nerves (that's what we are talking about here) work in the background, involuntarily, to regulate most of our critical body systems such as blood pressure, digestive system movement and the release of digestive enzymes, hormone release, temperature regulation, bladder control and heart rhythm as well as strength of contraction. The brain unconsciously oversees these activities through the parasympathetic and sympathetic pathways.
Your autonomic nervous system does not appear to be working normally, usually due to nerve damage from diabetes. Because of this I want you to be aware of the following:
1. Be especially alert for heart symptoms. You may have a reduced appreciation of cardiac ischemic pain. New, vague symptoms, such as cough, unexplained nausea, unexplained shortness of breath, unusual fatigue should be evaluated promptly.
2. Hypoglycemic Unawareness. Compared to other diabetics, you may not experience the early symptoms of sweating, tremor, or rapid heart rate before developing a dangerously low blood glucose. I recommend liberal glucose testing for this reason. Make sure your family knows to check your sugar if you are “acting or looking a little off” as your sugar may be low.
3. Orthostatic hypotension. You may have excessive blood pressure drops upon standing. Symptoms may include dizziness, weakness, and vision changes or even fainting. Please be advised to take extra precautions with showers and hot baths, during warm weather, after exercise and with fevers.
4. Exercise programs. Because your heart may not respond to the demands of exercise properly, you should use your "perceived" level of exertion to guide your intensity of exercise, not heart rate. Discuss this with me before adopting an exercise program more strenuous that what you are doing now.
5. Gastroparesis. Symptoms of gastroparesis can include nausea, heartburn, vomiting, early satiety, weight loss and bloating. Constipation can even alternate with diarrhea. Let’s talk if you are having symptoms that affecting your daily activity or lifestyle.
6. Sweating Impairment. Nerve damage may impair sweat gland function and limit your body’s ability to cool itself by sweating. This can lead to heat exhaustion or heat stroke in routine outdoor situations such as gardening or social events. Be alert for this. Also, I encourage the routine use of creams to the feet as excessively dry skin is prone to cracking and infection.
7. Visual Impairment. Autonomic dysfunction of the third cranial nerve, which controls pupil diameter, can impair your vision, particularly night vision. Please consider this in your travel planning.
8. Urge Incontinence. Patients often fail to disclose this embarrassing condition to their doctor. The inability of control urine flow is not uncommon and can usually be managed well with medication. Tell me if you are having problems.
*Feel free to use this Patient Handout with your Practice Title.