Diabetes Health Center

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Autonomic neuropathy-which affects nerves that regulate internal functions-can cause problems with digestion, urination, sweating, sexual function, blood pressure, and other involuntary body functions. Some symptoms of autonomic neuropathy can be hard to manage, but others respond well to treatment:

• Mild constipation. Eating small, frequent meals that are high in fiber and low in fat may help.
• Frequent diarrhea. Eating foods that are high in fiber may help. You may need medicines that slow the rate at which digested food and waste travel through the intestines, or you may need antibiotics such as tetracycline, amoxicillin, or metronidazole.
• Mild gastroparesis. This is a condition that causes the stomach to empty very slowly. It may get better if you eat small, frequent meals that are low in fiber and fat. Medicines that help the stomach empty more quickly may also be needed. Controlling blood sugar levels may reduce symptoms of gastroparesis.⁶
• Abnormal sweating. If you sweat a lot, try to avoid intense heat and humidity. If you sweat severely while eating certain foods, anticholinergic medicines may help. But these medicines have side effects that may sometimes be more troublesome than the abnormal sweating. Botulinum toxin (Botox) injections may also help. ⁵If you don't sweat enough, you can use moisturizers to help with dry or cracked skin. Drinking more water can prevent overheating. Try to avoid places that are very hot or very cold.
• Lack of awareness of low blood sugar level. This is also called hypoglycemia unawareness. You can adjust your insulin and allow your blood sugar levels to be a little bit higher than the target range. Usually it is recommended that you keep your A1c in a target range.
• Urinary problems. Urinary problems can be treated with antibiotics for urinary tract infections and medicines to improve bladder control.
• Sexual problems. Your doctor may suggest using medicines or devices to improve erections. Or you may need nonprescription lubricants and estrogen creams for vaginal dryness. For more information, see sexual problems.
• Blood pressure problems. Blood pressure problems can be treated with medicines and by wearing support stockings (also called compression stockings).

Treatment if the condition gets worse

If diabetic neuropathy gets worse, you may have serious problems such as severe gastroparesis, bladder infections, or foot problems. In addition to striving for tightly controlled, target range A1c levels and taking good care of your feet, you may need further treatment if diabetic neuropathy progresses.

Diabetic neuropathy is a major risk factor for foot infections or foot ulcers leading to amputation.⁷ It is possible to have permanent disfigurement in one or both of your feet (such as Charcot foot) from diabetic neuropathy. Surgery is sometimes needed to correct deformed joints that can result from Charcot foot. See a picture of Charcot foot .