Table 3. Symptoms and signs of diabetic autonomic neuropathy.

Cardiac autonomic neuropathy •  Resting tachycardia or fixed heart rate or both •  Loss of circadian rhythm of blood pressure •  Increase in nocturnal systolic blood pressure compared with daytime •  Orthostatic hypotension •  Exercise intolerance •  Syncope and light headedness •  Intra-operative cardiovascular lability •  ‘Silent ischemia’ and ‘painless’ myocardial infarction •  Arrhythmias •   Urogenital autonomic neuropathy Bladder dysfunction •  Increase in frequency and urgency particularly during the night •  Urinary hesitancy and weak stream •  Dribbling of urine and involuntary urination •  Urinary incontinence Sexual dysfunction •  Male: erectile dysfunction, decreased libido and abnormal ejaculation •  Female: decreased sexual desire and arousal, increased pain during intercourse and inadequate lubrication Gastrointestinal autonomic neuropathy •  Nausea/vomiting •  Bloating •  Inability to eat a full meal •  Profuse and watery diarrhoea (nocturnal) •  Constipation