Question

Topic: Discuss the link between Diabetes and effects on the Autonomic Nervous System, and the efficacy of different treatment regimes.

Answer 1

Uncontrolled diabetes causes ,

1. Increase glucose in nerves.
2. This increase polyol pathway which will increase free radical formation.
3. This leads to decrease NO (Nitric oxide) synthesis.
4. This will lead to increased vasoconstriction, ( Vasoconstriction is also produced by Increased endothelin , decreases GLA ).
5. Vasoconstriction will leads to endoneurial capillaries.
6. This will lead to nerve HYPOXIA.
7. Structural damage of nerves, decreased conduction velocity.

Cardiovascular - postural hypotension, painless MI, Resting Tachycardia, loss of heart rate variation. Treatment: Beta blockers, ACE inhibitors, clonidine, graded exercise programs, lifestyle advice, managing cardiovascular comorbidity.

GIT- Impaired motility, gasto atony, diarrhoea, enlarged gallbladder. Treatment: Prokinetics, Metaclopropamide, Domperidone, Mozapride.

Urogenital- Bladder dysfunction, impotence, retrograde ejaculation, loss of testicular sensation. Treatment: Prazosin, Bladder neck resection, Papaverin injection, prosthesis, sildenafil

Respiratory- Respiratory arrest

Pupillary abnormalities, Reduced Resting diameter, delayed or absent response to light.

Vasomotor - loss of skin vasomotor response.

Osteopathy, peripheral vascular changes, Charcot arthropathy, dependent edema, sudomotor diabetic anhydrous, gustatory sweating ( Emollients), Hypoglycemia unawareness.

Treatment of Hyperglycemia, metabolic abnormalities,

painful neuropathy (Treatment: Tricyclic drugs- Imipramine 25mg, Amitriptyline 25 mg). Anticonvulsant- Pregabalin 50 mg, other therapy- Topical capsaicin .075% cream.

Treatment of diabetic neuropathy is aimed at preventing the progression of neuropathy and treatment of complications.