Ewing DJ, Boland O, Neilson JM, Cho CG, Clarke BF: Autonomic neuropathy, QT interval lengthening, and unexpected deaths in male diabetic patients. Passive head-up tilting provides a more precise level of standardization to the orthostatic stimulus and reduces the muscular contraction of the legs, which can reduce lower-leg pooling of blood. Veglio M, Borra M, Stevens LK, Fuller JH, et al. The typical heart rate response to standing is largely attenuated by a parasympathetic blockade achieved with atropine (159). Patients with DAN show delayed or absent reflex response to light and diminished hippus due to decreased sympathetic activity and reduced resting pupillary diameter (7). 1B). Despite the increased association with mortality, the causative relationship between CAN and the increased risk of mortality has not been conclusively established. One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy (CAN), 1-3 which encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics. To test the heart rate response to standing, the patient is connected to the heart rate monitor while in the supine position. Johnson BF, Nesto R, Pfeifer M, Slater W, Vinik A, Wackers F, Young L: Systolic and diastolic dysfunction in diabetic patients with neuropathy (Abstract). Kennedy WR, Navarro X, Sutherland DER: Neuropathy profile of diabetic patients in a pancreas transplantation program. If celiac disease is suspected, measure serum levels of celiac disease antibody profile, including gliadin, endomysial, gluten, and reticulin antibodies. : Peripheral and autonomic nerve function tests in early diagnosis of diabetic neuropathy. Use blocks or risers under the head of your bed to keep your head raised and help with low blood pressure. The spectrum of reduced counterregulatory hormone responses (in particular epinephrine) and decreased symptom perception of hypoglycemia due to decreased ANS activation after recent antecedent hypoglycemia has been termed hypoglycemia-induced autonomic failure (147149).
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