Diabetic Autonomic Neuropathy

Aaron I. Vinik, MD, PhD.; Roy Freeman, MB, ChB.; Tomris Erbas, MD


Semin Neurol. 2003;23(4) 

In This Article

Sudomotor Dysfunction

Sudomotor dysfunction is a common feature of diabetic autonomic neuropathy. This generally manifests as anhidrosis of the extremities, which may be accompanied by hyperhidrosis in the trunk. Initially, patients display a loss of thermoregulatory sweating in a glove and stocking distribution that, with progression of autonomic neuropathy, extends from the lower to the upper extremities and to the anterior abdomen, conforming to the length dependency of diabetic neuropathy. This process ultimately may result in global anhidrosis. Hyperhidrosis may also accompany diabetic autonomic neuropathy. Excessive sweating may occur as a compensatory phenomenon involving proximal regions such as the head and trunk that are spared in a dying-back neuropathy. Gustatory sweating, the abnormal production of sweat that appears over the face, head, neck, shoulders, and chest after eating even nonspicy foods, is occasionally observed.[44]


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