[Significance and diagnosis of autonomic neuropathy in diabetes]

The results of studies performed to date would appear to show that autonomic neuropathy (ANP) in diabetics can involve any organ system. The earliest and most common manifestation is seen in the cardiovascular system, and finds expression as orthostatic phenomena, resting tachycardia, and "rigid pulse". Simple, non-invasive tests permit accurate quantification and follow-up. ANP in the gastrointestinal tract manifests as a motility disturbance, and the resulting delay in absorption might be the cause of inexplicable blood sugar fluctuations. A phenomenon of decisive importance for the diabetic is the lowering of his awareness of a hypoglycemic state. For this reason, intensive training of the diabetic in the self-determination of blood sugar and requirement-matched insulin dosage are thus of extreme importance. Disturbances of sexual function, which are all too rarely mentioned, usually put a heavy strain on the diabetic. Medical care of diabetics prior to, during and after surgery should give due consideration to cardiac, pulmonary and gastrointestinal ANP involvement. In view of the limited therapeutic possibilities, prevention of ANP should receive top priority.