How many things happen in our bodies without us even realizing it? We don't always think about things like breathing, heartbeat, digestion, and controlling body temperature. These things happen automatically, like the auto-pilot system of a car. Everything that happens automatically is controlled by a special part of our nervous system. But, what happens if this nervous system is damaged due to certain diseases? That's when this automatic control starts to go haywire. `Autonomic Neuropathy`, which we are talking about today, is about such a condition.
What is this Autonomic Neuropathy?
Simply put, `Autonomic Neuropathy` is damage to the nerves that control the automatic functions of our body. These nerves are called the `Autonomic Nervous System`. These nerves, together with our brain and spinal cord, control the functioning of major organs such as the heart, stomach, intestines, and bladder.
Just think, even things like the black circles in your eyes getting bigger when you go into a dark room, or the mouth watering when you smell a delicious food, are controlled by this system. So when these nerves are damaged, these automatic things don't work properly. The main things that can be affected are:
- Blood pressure
- Heart rate
- Digestion
- Urination
- Bowel movements
- Body temperature control
- Sexual function
What are the symptoms of this?
The symptoms you experience will depend on which nerves are affected. Symptoms can vary from person to person. Let's take a look at the main symptoms.
| Affected system | Possible symptoms |
|---|---|
| Digestive system | Diarrhea, constipation, feeling full even after eating a small amount of food, vomiting, regurgitation of undigested food, difficulty swallowing, and chest pain. |
| Heart and blood vessels | Dizziness or fainting caused by a sudden drop in blood pressure when standing up, rapid heartbeat (especially during exercise), high blood pressure. |
| Urinary system | Difficulty urinating, inability to control urine, inability to completely empty the bladder, frequent urinary tract infections. |
| Body temperature | Sweating at night, sweating excessively or very little, sweating while eating. |
| Sexual activity | Men experience difficulty getting an erection, women experience vaginal dryness, decreased sexual desire, and problems achieving orgasm. |
| Lungs and vision | Difficulty breathing, difficulty adjusting vision when going from a bright place to a dark place, difficulty driving at night. |
Diabetes and Hypoglycemia Unawareness
If a person with diabetes develops `Autonomic Neuropathy`, another serious complication can occur. That is, not recognizing the warning signs of dangerously low blood sugar levels (Hypoglycemia). Doctors call this `Hypoglycemia Unawareness`.
Normally, if your autonomic nervous system is functioning properly, when your blood sugar drops dangerously low, you will experience symptoms like shaking, sweating, and a rapid heartbeat. These are the "warning signs" that your body gives you. However, someone with Autonomic Neuropathy may not feel these warning signs.
This is a very dangerous situation because, if you don't realize that your blood sugar is getting low, you could faint, lose consciousness, or have even worse consequences.
If you have this type of `Hypoglycemia Unawareness`, your doctor will tell you to check your blood sugar levels frequently. They may also recommend using a `Continuous Glucose Monitor`, which measures your blood sugar levels regularly and sounds an alarm if it drops.
What are the reasons for this situation?
The main and most common cause of this nerve damage is diabetes . Over time, uncontrolled diabetes can damage these nerves. Apart from that, there can be a number of other causes.
- Diabetes: The main cause.
- Autoimmune diseases: Diseases in which the body's own immune system attacks the nerves. Examples include `Rheumatoid Arthritis`, `Lupus`, `Guillain-Barré syndrome`.
- Certain infections: Infections such as HIV and Lyme disease.
- Other diseases: Parkinson's disease, amyloidosis, a disease caused by abnormal protein deposits.
- Some medications given for cancer: Certain chemotherapy drugs.
- Excessive alcohol consumption.
- Surgeries or injuries to the spine.
- Exposure to chemicals: For example, heavy metals.
- Some hereditary diseases.
How to diagnose the disease?
There is no single test to diagnose this condition. Your doctor will first listen to your symptoms and perform a physical exam. Then, they may recommend several blood tests to find the cause.
- Check for diabetes.
- Check for other autoimmune diseases.
- Check for infections like HIV.
In addition, other special tests may be performed depending on the symptoms:
- Tilt-table test: You lie down on a bed-like device and your upper body is gradually raised as if you were standing. Your blood pressure and heart rate are monitored. This is especially useful for people who get dizzy when they stand up.
- Quantitative Sudomotor Axon Reflex Test (QSART): This tests how your sweat glands work using a very small electrical current.
- Urodynamic tests: Tests that check how well the bladder stores and empties urine.
- Ultrasound scan: This helps to get images of the inside of organs like the bladder and see exactly what the problem is.
- Gastric emptying test: A test that checks for irregular digestion, especially slow stomach emptying (Gastroparesis).
How is it treated?
The main treatment here is to treat the underlying disease that caused the nerve damage . For example, if you have diabetes, you need to control your blood sugar levels well through diet, exercise, and, if necessary, medication. If it is an `autoimmune` disease, you need to get appropriate treatment for it.
At the same time, the doctor will also recommend various things to control the symptoms that have arisen.
Important: Always consult your doctor before following any medication or method mentioned here.
| Symptom/System | Things to do and treatments |
|---|---|
| Digestive problems | - Don't eat a lot at once, eat several small meals. - Avoid constipation by consuming more fiber-rich foods and fluids. - Taking laxatives as prescribed by a doctor. - Taking medication for diarrhea and stomach pain. |
| Urinary problems | - Establish a habit of urinating at regular times. - Taking medications that help empty the bladder completely. - Removing urine by inserting a catheter into the bladder. |
| Sweating problems | - Taking medications that reduce sweating (e.g. glycopyrrolate) as prescribed by a doctor. - Staying indoors during extreme heat. |
| Heart and blood pressure problems | - Taking medications that increase blood pressure (fludrocortisone, midodrine). - Taking medications such as `beta-blockers` to control heart rate. - Get up slowly to avoid dizziness. - Only take in a little more salt and fluids if recommended by your doctor. |
| Sexual problems | - Use of drugs such as `sildenafil (Viagra)` for erectile dysfunction, as prescribed by a doctor. - For women, use a water-based lubricant to relieve vaginal dryness. |
Take-Home Message
- Autonomic neuropathy is damage to the nerves that control automatic functions in our body (such as heartbeat, digestion).
- Although the most common cause of this is diabetes, a number of other diseases and causes can contribute.
- Unrelated symptoms such as dizziness, sweating abnormalities, digestive problems, and difficulty urinating may suddenly appear.
- The key to treatment is to treat the underlying cause. Especially if you have diabetes, controlling your blood sugar levels well can slow down and possibly even reverse some of the nerve damage.
- If you have symptoms like these, it is very important not to ignore them, but to see a doctor as soon as possible to determine the cause and receive the necessary treatment.
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