Gastrointestinal, genitourinary, and neurovascular disturbances in diabetes

The gastrointestinal, genitourinary, and neurovascular systems are frequent targets of the autonomic complications of diabetes. Complications affectin g these systems contribute greatly to the morbidity, mortality; and reduced quality of life and activities of daily living of the person with diabetes . They are also the major source of increased costs of caring for the diabe tic patient, impairments range from functional disturbances related to hype r- or hypoglycemia and age, duration of diabetes, and quality of diabetes c ontrol and evolve into organic disorders with loss of parasympathetic, symp athetic, and neuropeptidergic nerves, Factors in the pathogenesis are metab olism, vascular insufficiency, loss of growth factor trophism, and autoimmu ne destruction of small unmyelinated nerves (C fibers) in a visceral and cu taneous distribution. The clinical manifestations range from anorexia, naus ea, vomiting, brittle diabetes, diarrhea, constipation, loss of bladder con trol, and erectile dysfunction to impaired skin blood flow responses to hea ting and cooling, nociception, and gravity, with loss of amplitudes of vasc ular oscillation and premature aging of the neurovascular system. The disor dered skin blood flow is a major factor in the development of foot ulcers a nd amputations. Treatments are limited to symptoms; algorithms for the many facets of these disorders are provided here? including one for gastrointes tinal abnormalities and another for erectile dysfunction. Ultimately, treat ment directed at the underlying pathogenic mechanisms of these manifestatio ns is sorely needed.