AUTONOMIC NEUROPATHY
(Gastroparesis, Diarrhea, Constipation, Urinary Problems)

One diabetes complication that is less talked about is called "autonomic neuropathy".  This type of neuropathy can make a person unable to control their urination and can contribute to diarrhea and constipation.  Since basic parts of your life are no longer in control it can be extremely difficult to talk about it. This diabetic complication is often ignored so a vast majority of the people that have it don't understand it or how it can be treated.

If you have this complication taking the time to learn about it may help make the job of dealing with it a little easier.  If you don't have it learning about it may minimize the effects it can have on your body if you develop it later.

The word "autonomic" refers to something your body does automatically without you being aware that it is happening to you.  For example, you don't have to tell your lungs to exhale and inhale, yet it occurs over and over every day.  Body functions like this are controlled by the autonomic nervous
system, also known as the involuntary or subconscious nervous system.  This nervous system controls your heart, lungs, intestines, blood vessels, stomach, bladder and the sex organs,
as well as other organs of the body.

If these nerves get damaged it is called "autonomic neuropathy".  It usually occurs over a period of time rather than all at once.  If someone has this type of neuropathy and doesn't know it, it is
referred to as "silent neuropathy".  When this type of neuropathy is undetected and/or untreated it can lead to serious consequences.
 

GASTROPARESIS

One of the most common types of autonomic nerve damage is called "gastroparesis", and it affects the nerves in the stomach.   Gastroparesis can be found in about 25 percent of diabetics.  It occurs when your stomach isn't able to move or propel food though your body's digestive system.  Different foods move through your body at different rates.  Liquids pass through the quickest and
some solid foods (like fatty foods), the slowest.

They symptoms of gastroparesis can be mild and may go unnoticed for several years.  Even your doctor may not notice the condition unless you are having trouble coordinating the arrival of food in your blood stream with the peak action of your insulin.  Because of this your diabetes may be called "brittle" or fluctuate up and down in a way that doesn't seem related to the timing or dose of
your insulin injections.

As this diabetic complication progresses you may feel bloated, and/or experience nausea, vomiting, and you may feel full after eating small meals.  Some people with gastroparesis say they can taste on their breath a meal they ate two or more days before, or when they vomit they find undigested food eaten more then one meal before.

Your doctor can perform a "gastroscopy" (an examination of the stomach) to see if what you're experiencing is really gastroparesis.  You may also be asked to eat a small, relatively harmless amount of radioactive dye that can be traced as it works its way through your digestive tract.

Treatment for gastroparesis may include changing your diet and/or using medications.  Eating six or more small meals in a liquid form has been known to help.  Foods low in dietary fiber and fat are more helpful because fat slows down the digestive process of the stomach and fiber is difficult to digest.
 

DIARRHEA

Diarrhea can also be caused by damage to the intestinal nerves or the lost of digestive enzymes from the pancreas.

To treat diabetes-related diarrhea, your doctor may prescribe medication.
 

CONSTIPATION

Constipation is usually treated by having the person consume plenty of water, and at times that may be all that is required.  A drug may also be given that works as a fecal softener.  Other
drugs can help in the functioning of the large bowel.
 
 

URINARY PROBLEMS

The urinary bladder and the sphincter muscle near your anus are regulated by the autonomic nervous system.  Your urinary bladder is the reservoir that collects urine (about one to one-and-a-half  cups a day), until it is convenient for you to pass it out of your system.  Most healthy people don't worry about uncontrolled urination since their sphincter muscle contracts and stops any leakage.  Diabetics may have damage to the nerves in their urinary system and may suffer from uncontrolled urination.

If you have damage to the nerves to your bladder you may not be able to sense that your bladder is filling up.  You may also have trouble spontaneously emptying your bladder.  This can lead to your bladder becoming susceptible to infection.  You may urinate less frequently and the overflow of excess urine can cause incontinence (dribbling and wetting oneself).

Your doctor may give you an ultrasound test to ascertain the shape, size and position of your bladder.
 

CONTROLLING YOUR DIABETES CAN HELP

Controlling your diabetes is one of the most important ways to protect your nerves from damage caused by high blood glucose levels.  You should also avoid alcohol and cigarettes as well.  If your autonomic nerve damage is already severe, however, tight control might not be for you.  When your nerves are damages, you many not be able to feel some of the usual signs of hypoglycemia (low blood sugar), such as tingling.