Cardiac Autonomic Neuropathy: Impact on Severe Hypoglycemic Unawareness and Orthostatic Hypotension in Diabetic Dysautonomia, a Case Series and Review.
Document Type
Article
Publication Date
12-2024
Publication Title
Cardiovascular Endocrinology & Metabolism
Abstract
Diabetic autonomic neuropathy (DAN) and its associated cardiovascular autonomic neuropathy (CAN) can lead to potentially fatal complications. We analyzed two distinct cases of DAN/CAN based on comprehensive cardiovascular autonomic reflex tests (CARTs). Case 1 involves a 27-year-old patient with T1DM suffering from recurrent severe hypoglycemic unawareness due to DAN. After implementing an automated insulin delivery system, the glucose management improved significantly. Case 2 describes a 60-year-old patient with type 2 diabetes experiencing debilitating orthostatic hypotension. The initiation of Midodrine and Fludrocortisone markedly improved symptoms and capacity of daily activities. This observational study highlights the critical yet frequently overlooked severe manifestations of DAN/CAN, specifically hypoglycemic unawareness and orthostatic hypotension. CARTs play a pivotal role in confirming the diagnosis and guiding therapeutic decisions. Tailored interventions, including advanced technologies like automated insulin delivery systems for T1DM and pharmacotherapy targeting neurogenic orthostasis, can significantly improve patient outcomes and quality of life.
Volume
13
Issue
4
First Page
e00319
Recommended Citation
Wu C, Devireddy R, Zazaian A, Kambhatla S, Alzohaili O, Saad C. Cardiac autonomic neuropathy: impact on severe hypoglycemic unawareness and orthostatic hypotension in diabetic dysautonomia, a case series and review. Cardiovasc Endocrinol Metab. 2024 Dec;13(4):e00319. doi: 10.1097/XCE.0000000000000319. PMID: 39574826.
DOI
10.1097/XCE.0000000000000319
ISSN
2574-0954
PubMed ID
39574826
