Treatment. Different types of autonomic neuropathy call for different treatments.
Feeling full or bloated may be helped by eating small frequent meals instead of three large ones.

Medications, such as metoclopramide, can help food to move through your stomach. There are other medications and dietary adjustments that you can use to treat constipation or diarrhea.

Incontinence, or urine leakage, can be treated by training in bladder control and timed urination using a planned bladder-emptying program. Rather than waiting until your bladder feels full, you can try urinating every 2 hours. Men sometimes find it easier to urinate sitting down. Applying pressure over the bladder may also be helpful. If these steps don’t work, oral medication may be needed. Or you may need to use a catheter or have surgery. Fecal incontinence (passing stool involuntarily) is treated in a similar way, with medicine for diarrhea and biofeedback training.

If you are experiencing a sudden drop in blood pressure when you stand up, there are several treatment options. If you drink alcohol or take medications, such as diuretics, ask your provider about stopping them. Other options include medications for low blood pressure, raising the salt content of your diet, or raising the head of your bed. However, low blood pressure in itself is not unhealthy. It only becomes a problem if it makes you dizzy or disoriented. Try to stand up more slowly and avoid staying still for long periods to prevent fainting.

When you get up in the morning, sit on the edge of the bed before you stand up.

Sometimes neuropathy can trigger a cascade of diabetes-related complications. For example, many people who have had diabetes for a long time develop a condition known as Charcot’s foot.  This disorder usually affects weight-bearing joints, such as the ankles. It may start with a loss of feeling and thinning of bones in the feet. This can lead to a painless fracture.

Because the injury doesn’t cause pain, it can go unnoticed and untreated.  You may continue walking on the fracture, making matters worse. Muscle shrinking (atrophy) and joint damage can occur and add to the damage, which can become severe enough to deform the foot. The key to treating Charcot’s foot is early non–weight-bearing. This involves keeping weight off the joint and wearing special footwear. If you notice any swelling in a joint, especially in your ankle or foot, see your provider right away.

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Martha M. Funnell, MS, RN, CDE
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Robert M. Anderson, EdD
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Shereen Arent, JD
National Director of Legal Advocacy
American Diabetes Association

American Diabetes Association Complete Guide to Diabetes