Resolution of diabetic autonomic neuropathy

• Published in: Postgraduate medical journal 2002-06, Vol.78 (920), p.360-361
• Main Authors: Burden, M L, Burden, A C
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anorexia; Anorexia Nervosa - complications; Anorexia Nervosa - therapy; Associated diseases and complications; Autonomic Nervous System Diseases - complications; Autonomic Nervous System Diseases - therapy; autonomic neuropathy; Biological and medical sciences; Case Report; Case studies; Complications and side effects; Diabetes; diabetes mellitus; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - complications; Diabetic Neuropathies - therapy; Diseases; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Endoscopy; Fashion designers; Female; Humans; Hypoglycemia; Insulin; Insulin - therapeutic use; Male; Medical sciences; Nervous system, Autonomic; Nutrition; Pain; Peripheral nerve diseases; Posture; Ratios; Respiration; Weight Gain
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pmj.78.920.360

Many consider diabetic autonomic neuropathy to be an irreversible complication of diabetes of long duration. Three patients developed symptoms of autonomic neuropathy which subsequently resolved. Their autonomic neuropathy was not associated with long duration of diabetes, but with weight loss. Each had marked weight loss and resolution occurred on regaining remembered premorbid weight. A woman aged 20 was admitted with anorexia nervosa (weight loss 6 kg). She complained of feeling bloated. Gastroenterological investigations showed delayed gastric emptying. RR ratio (respiration and standing) was abnormal. Resolution occurred after two years. A male aged 18 developed diabetic symptoms, which were overlooked. Twelve months later he presented underweight and ketonuric; insulin treatment was started but within one month he became impotent. Resolution occurred after 18 months. An 80 year old man presented after six months trial of diet and sulphonylurea therapy. He was underweight, had ketonuria, and such muscle loss that he was unable to sit unaided. Insulin treatment was started. He developed severe symptomatic postural hypotension. This resolved six months later by which time he had regained his normal weight. These cases illustrated symptomatic autonomic neuropathy occurring in relation to weight loss with resolution on recovery of normal weight, a temporal pattern mimicking that of acute cachectic painful neuropathy. Treatment of autonomic neuropathy should be like that of cachectic neuropathy, that is with an expectation of recovery and should include strategies to regain premorbid weight and achieve glycaemic control