Autonomic Neuropathy: Symptoms, Causes, Tests & Treatment — Complete Guide
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What Is Autonomic Neuropathy?
Autonomic neuropathy is damage to the nerves that control your body's automatic functions — blood pressure, digestion, bladder control, sweating, temperature regulation, and sexual function. Diabetes is the most common cause, especially when blood sugar is poorly controlled. The condition cannot be cured, but treating the underlying disease and managing each symptom separately can slow progression.
What the research says
Cardiac autonomic neuropathy roughly triples the risk of heart events and death in diabetes. In a meta-analysis of 26 studies in type 1 and type 2 diabetes, people with cardiac autonomic neuropathy (2,875 people) had a pooled relative risk of 3.16 (95% CI 2.42–4.13) of future cardiovascular events compared with 11,722 people without it, and a pooled relative risk of 3.17 (95% CI 2.11–4.78) for all-cause mortality (3,679 with versus 12,420 without); the risk was higher in type 1 than type 2 diabetes. (Chowdhury et al., BMJ Open Diabetes Res Care, 2021) [3]
Intensive early blood sugar control protects the nerves. In the DCCT/EDIC study of type 1 diabetes, intensive therapy reduced the risk of diabetic peripheral neuropathy by 64% and cardiovascular autonomic neuropathy by 45% at the end of the DCCT, and the prevalence and incidence of both stayed significantly lower in the intensive-therapy group through EDIC year 13/14. (Martin et al., Diabetes Care, 2014) [4]
Blood pressure drops on standing are common and linked to higher mortality. Orthostatic hypotension affects about 20% of older adults and 5% of middle-aged adults in the community, diabetes raises its prevalence at every age, and it is associated with up to a 50% increase in the relative risk of all-cause mortality; midodrine and droxidopa are first-line medicines, while fludrocortisone has concerning long-term effects. (Kim & Farrell, Am Fam Physician, 2022) [5]
Autonomic Neuropathy at a Glance
Aspect | Summary |
What it is | Nerve damage affecting automatic body functions (blood pressure, digestion, bladder, sweating, sexual function) |
Most common cause | Diabetes, especially when poorly controlled |
Other causes | Amyloidosis, autoimmune diseases, chemotherapy, infections (HIV, Lyme disease, botulism), inherited disorders |
Who is at risk | People with poorly controlled diabetes, amyloidosis, porphyria, hypothyroidism, or cancer receiving nerve-damaging treatment |
Key symptoms | Dizziness on standing, urinary problems, digestive trouble, sweating problems, sluggish pupils, exercise intolerance |
Diagnosis | Autonomic function tests, tilt-table test, gastric-emptying tests, sweat gland tests, bladder function tests, ultrasound |
Treatment | Control the underlying disease + symptom-specific medicines, diet changes, devices, and self-care habits |
Outlook | Not curable, but progression can be slowed; most people improve daily function with treatment |
What Is Autonomic Neuropathy?
Your autonomic nervous system is the body's automatic pilot. It keeps your heart beating, your blood vessels adjusting, your stomach digesting, and your sweat glands working — all without you thinking about it. Autonomic neuropathy occurs when the nerves in this system are damaged, so the messages between your brain and your organs get disrupted.
The damage can affect the heart, blood vessels, and sweat glands, and it changes how these organs respond to everyday demands. The symptoms you experience depend entirely on which nerves are damaged — so two people with the same diagnosis can have very different symptom patterns.
What are the signs and symptoms of autonomic neuropathy?
Symptoms depend on which autonomic nerves are damaged. The most common patterns are listed below.
Dizziness and Fainting on Standing
A sudden drop in blood pressure when you stand up is one of the classic early signs. You may feel dizzy, lightheaded, or even faint after getting out of a chair or out of bed.
Urinary Problems
Nerve damage to the bladder causes difficulty starting urination, loss of bladder control, trouble sensing when the bladder is full, and an inability to completely empty the bladder. Incomplete emptying raises the risk of repeated urinary tract infections.
Sexual Difficulties
Men may develop problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems. Women may experience vaginal dryness, low libido, and difficulty reaching orgasm.
Digestive Trouble
Damage to the digestive nerves can cause many symptoms at once: feeling full after only a few bites, loss of appetite, diarrhea or constipation, abdominal bloating, nausea, vomiting, difficulty swallowing, and heartburn.
Hidden Blood Sugar Drops
The body's warning signals for low blood sugar (hypoglycemia) — such as shakiness — may simply stop working. This is one of the more dangerous effects, because the person cannot recognize and treat a dangerous blood sugar drop.
Sweating and Temperature Problems
People may sweat too much or too little. Abnormal sweating interferes with the body's ability to regulate temperature.
Sluggish Pupils
Pupils react slowly, making it hard to adjust from light to dark and to see well when driving at night.
Exercise Intolerance
The heart rate may stay the same instead of adjusting to activity level, making exercise feel much harder than it should.
Affected system | What you may notice |
Blood pressure | Dizziness and fainting when standing |
Bladder | Trouble starting, incomplete emptying, loss of control, more UTIs |
Sexual function | Erectile dysfunction (men); dryness, low desire (women) |
Digestion | Early fullness, bloating, nausea, vomiting, diarrhea or constipation |
Blood sugar signals | Can no longer sense low blood sugar |
Sweating | Too much or too little sweating; temperature trouble |
Eyes | Sluggish pupils; poor night vision |
Heart | Heart rate does not rise with exercise |
When should you see a doctor about autonomic neuropathy?
Seek medical care promptly if you begin having any of the signs above — particularly if you have poorly controlled diabetes.
Screening matters even before symptoms appear:
Type 2 diabetes: annual autonomic neuropathy screening is recommended from the time of diagnosis.
Type 1 diabetes: annual screening is advised beginning five years after diagnosis.
What Causes Autonomic Neuropathy?
Many health conditions can cause autonomic neuropathy, and it can even be a side effect of treatments for other diseases, such as cancer.
Diabetes is the most common cause, especially when blood sugar is poorly controlled. Over time, diabetes gradually damages nerves throughout the body.
Amyloidosis — irregular protein buildup in organs — damages both organs and the nervous system.
Autoimmune diseases make the immune system attack the body's own tissues, including nerves. Examples include Sjogren syndrome, systemic lupus erythematosus, rheumatoid arthritis, and celiac disease. Guillain-Barre syndrome is a rapid autoimmune disease that can affect autonomic nerves, and an immune attack triggered by some cancers (paraneoplastic syndrome) can also be responsible.
Certain medications, including some cancer-treatment drugs (chemotherapy), can damage autonomic nerves.
Viruses and bacteria, such as HIV and the organisms that cause botulism and Lyme disease, are also known causes.
Certain inherited disorders can produce autonomic neuropathy as well.
Cause category | Examples |
Metabolic | Diabetes (most common), especially poorly controlled |
Protein buildup | Amyloidosis |
Autoimmune | Sjogren syndrome, lupus, rheumatoid arthritis, celiac disease, Guillain-Barre, paraneoplastic syndrome |
Medications | Some chemotherapy drugs |
Infections | HIV, Lyme disease, botulism |
Genetics | Certain inherited disorders |
What are the risk factors for autonomic neuropathy?
The two main risk factors for autonomic neuropathy are diabetes, especially when blood sugar is hard to control, and other diseases such as amyloidosis, porphyria and hypothyroidism.
Diabetes — the risk is greatest when blood sugar is difficult to control.
Other diseases — amyloidosis, porphyria, and hypothyroidism all increase risk. Cancer raises risk too, usually because of side effects from treatment rather than the cancer itself.
Can Autonomic Neuropathy Be Prevented?
Autonomic neuropathy cannot always be prevented, because inherited diseases that raise the risk cannot be prevented. However, you can slow the onset or progression of symptoms by taking care of your general health and managing your medical conditions:
Control your blood sugar if you have diabetes.
Avoid alcohol and smoking.
Get appropriate treatment if you have an autoimmune disease.
Prevent or control high blood pressure.
Achieve and maintain a healthy weight.
Exercise regularly.
How is autonomic neuropathy diagnosed?
The tests you need depend on your symptoms and your risk factors.
When You Have Known Risk Factors
If you have diabetes or another risk-increasing condition plus neuropathy symptoms, your provider will perform a physical exam and ask about your symptoms. If you are receiving cancer treatment with a drug known to cause nerve damage, your provider will actively check for signs of neuropathy.
When You Have No Known Risk Factors
Diagnosis becomes more involved. After a medical history review, symptom discussion, and physical exam, your provider may order several autonomic function tests:
Test | What it measures |
Autonomic function tests | How heart rate and blood pressure respond to deep breathing and the Valsalva maneuver (forceful breathing out) |
Tilt-table test | Blood pressure and heart rate response to posture changes; the table tilts to raise your upper body, simulating standing after lying down |
Simple posture tests | Blood pressure lying, sitting, and standing (after 3 minutes); or standing 1 minute, squatting 1 minute, standing again |
Gastrointestinal tests | Gastric-emptying tests, the most common check for slow digestion and gastroparesis (performed by a gastroenterologist) |
Quantitative sudomotor axon reflex test (QSART) | How sweat-gland nerves respond to small electrical currents through capsules on the forearm, leg, and foot |
Thermoregulatory sweat test | A color-changing powder documents your sweat pattern as chamber temperature slowly rises |
Urinalysis and urodynamic tests | Bladder function when urinary symptoms are present |
Ultrasound | Imaging of the bladder and urinary tract for bladder symptoms |
Normally, when you stand up, your blood vessels narrow and your heart rate increases to compensate for the blood pressure drop. In autonomic neuropathy, this response is slowed or weakened — which is exactly what the posture tests detect.
How is autonomic neuropathy treated?
Autonomic neuropathy treatment has two goals: treating the underlying disease and managing specific symptoms based on which part of the body is most affected.
Treating the underlying disease — the first and most important goal. If diabetes is causing the nerve damage, tightly controlling blood sugar prevents further damage. Note that in about half of cases, no underlying cause is ever found.
Managing specific symptoms — based on which part of the body is most affected.
Digestive (Gastrointestinal) Symptoms
Diet changes: more fiber and fluids; fiber supplements such as Metamucil or Citrucel may help. Increase fiber slowly to avoid gas and bloating.
Metoclopramide (Reglan): a prescription drug that helps the stomach empty faster by increasing digestive tract contractions. It can cause drowsiness and should not be used longer than 12 weeks.
Constipation relief: over-the-counter laxatives — ask your provider how often to use them.
Diarrhea relief: antibiotics (to prevent excessive bacterial growth in the intestines) and over-the-counter anti-diarrheal medication.
Urinary Symptoms
Bladder retraining: a schedule of when to drink fluids and when to urinate increases bladder capacity and helps it empty completely at the right times.
Medications to calm an overactive bladder or to help it empty.
Catheterization: a tube guided through the urethra to empty the bladder.
Sexual Dysfunction
For men, medicines such as sildenafil (Viagra), vardenafil, tadalafil (Cialis), and avanafil (Stendra) can help achieve and maintain an erection. Possible side effects include low blood pressure, mild headache, flushing, upset stomach, and changes in color vision. Use these drugs with caution if you have a history of heart disease, arrhythmia, stroke, or high blood pressure, and never combine them with organic nitrates. Seek immediate medical help if an erection lasts longer than four hours. An external vacuum pump — a hand pump that pulls blood into the penis, held in place by a tension ring — can maintain an erection for up to 30 minutes.
For women, providers may recommend vaginal lubricants to reduce dryness and make intercourse more comfortable, or one of the few medicines approved for premenopausal women with low sexual desire.
Heart Rhythm and Blood Pressure Problems
High-salt, high-fluid diet — recommended only for severe cases of low blood pressure on standing (never for people with heart failure).
Compression garments — an abdominal binder or thigh-high compression stockings to improve blood flow.
Blood pressure medicines — fludrocortisone (helps the body retain salt), midodrine (Orvaten) and droxidopa (Northera) (raise blood pressure but can cause high blood pressure when lying down), octreotide (Sandostatin) (helps diabetics with low blood pressure after eating), and pyridostigmine (Mestinon) (keeps blood pressure stable when standing).
Beta blockers to regulate a heart rate that rises too high during activity.
Sweating Problems
Glycopyrrolate (Cuvposa, Robinul, and others) can reduce excessive sweating. Side effects include dry mouth, blurred vision, diarrhea, urinary retention, changes in heart rate, headache, loss of taste, and drowsiness. It can also raise the risk of heat-related illness such as heatstroke because sweating ability is reduced.
Which self-care habits help with autonomic neuropathy at home?
Self-care habits for autonomic neuropathy include changing posture in stages, raising the head of the bed, eating small frequent meals and keeping tight blood sugar control.
Change posture in stages: before getting up, sit with your legs dangling off the bed for a few minutes; flex your feet and make fists to increase blood flow; stand up slowly. Once standing, tense your leg muscles while crossing one leg over the other a few times.
Raise the head of your bed about 4 inches (10 centimeters) with blocks or risers if you have low blood pressure.
Eat small, frequent meals with more fluids, choosing low-fat, high-fiber foods to improve digestion.
Keep tight blood sugar control if you have diabetes — it lessens symptoms and prevents or delays new problems.
Which alternative medicine options may help autonomic neuropathy?
Alternative treatments that might help autonomic neuropathy include alpha-lipoic acid, acupuncture and transcutaneous electrical nerve stimulation (TENS), though they should be discussed with a provider first.
Alpha-lipoic acid, an antioxidant with research suggesting it may improve measures of autonomic nerve function (more study needed).
Acupuncture, which might help with slow stomach emptying and erectile dysfunction (more studies needed).
Transcutaneous electrical nerve stimulation (TENS), which sends low-energy electrical waves through skin electrodes and may ease pain associated with diabetic neuropathy.
How can people cope with autonomic neuropathy and find support?
Living with a chronic condition brings daily challenges. Setting priorities helps — do the most important tasks (paying bills, grocery shopping) when you have the most energy, and save the rest for later. Stay active without overdoing it.
Accept help from friends and family; a support system and a positive attitude are powerful coping tools. And because depression is a possible complication of autonomic neuropathy, talking to a counselor or therapist is a legitimate and often essential part of treatment. Support groups — local or online, or groups for your underlying condition such as diabetes — can also help.
How should you prepare for an autonomic neuropathy appointment?
You will probably start with your primary care provider. If you have diabetes, you might see your endocrinologist (diabetes specialist). You may be referred to a neurologist (nerve specialist), and depending on which body systems are affected, a cardiologist (for blood pressure and heart rate problems) or a gastroenterologist (for digestive difficulties).
What You Can Do
Ask whether you should do anything before the appointment, such as fasting before certain tests. Then make a list of:
Your symptoms and when they began
All medications, vitamins, and supplements you take, including doses
Questions to ask your provider
Take a friend or family member with you to help remember the information — especially if you are at risk of passing out from low blood pressure, people around you need to know what to do.
Questions to ask your provider
Why did I develop autonomic neuropathy?
Could anything else cause my symptoms?
What tests do I need?
What treatments are available?
Are there alternatives to the treatment you're suggesting?
Is there anything I can do to help manage autonomic neuropathy?
I have other health conditions — how can I best manage those alongside it?
Do I need to follow a special diet?
Are there activities I need to restrict?
Do you have printed materials or websites you recommend?
What Your Doctor Will Likely Ask
Have your symptoms been continuous or occasional?
How severe are your symptoms?
Does anything seem to improve your symptoms?
What appears to worsen your symptoms?
Frequently Asked Questions
What is autonomic neuropathy?
Autonomic neuropathy is damage to the nerves that control automatic body functions such as blood pressure, digestion, bladder control, sweating, and sexual function. It disrupts the messages sent between the brain and organs like the heart, blood vessels, and sweat glands.
What causes autonomic neuropathy?
Diabetes — especially when poorly controlled — is the most common cause. It can also result from amyloidosis, autoimmune diseases such as lupus or celiac disease, some chemotherapy drugs, infections like HIV or Lyme disease, and certain inherited disorders.
What are the first symptoms of autonomic neuropathy?
Common early signs include dizziness or fainting when standing (from a sudden blood pressure drop), bladder problems, digestive trouble such as early fullness and bloating, sweating too much or too little, and sluggish pupils that make night driving difficult.
Is autonomic neuropathy dangerous?
Autonomic neuropathy can be. Blood pressure drops can cause fainting injuries, incomplete bladder emptying leads to infections, and some people lose the ability to recognize dangerous low blood sugar. Seeking prompt care and managing the underlying condition reduces these risks.
How is autonomic neuropathy diagnosed?
Diagnosis typically involves a physical exam plus autonomic function tests that measure how your heart rate and blood pressure respond to deep breathing, the Valsalva maneuver, and posture changes such as a tilt-table test. Gastric-emptying tests, sweat tests, and bladder function studies may also be used.
Can autonomic neuropathy be cured?
There is no cure for existing nerve damage, but treating the underlying disease (such as tightly controlling blood sugar) prevents further damage, and symptom-specific treatments — diet changes, medicines, compression garments, and bladder training — greatly improve daily life.
What self-care helps with autonomic neuropathy?
Stand up slowly in stages, raise the head of your bed about 4 inches, eat small frequent low-fat high-fiber meals, keep blood sugar tightly controlled, avoid alcohol and smoking, and exercise regularly.
Conclusion
Autonomic neuropathy is a condition most people never think about until the body's automatic systems start misfiring — dizziness on standing, bladder trouble, digestion problems, and hidden blood sugar drops. This guide covered what it is, why diabetes is the leading cause, the full symptom list, how it is diagnosed with autonomic function and tilt-table tests, and the two-goal treatment approach that addresses both the underlying disease and each specific symptom.
The three lessons to keep:
Know your risk: poorly controlled diabetes is the leading cause — annual screening saves function.
Name the symptom: treatment is built symptom by symptom, so report every change to your doctor.
Small habits matter: slow posture changes, bed elevation, and small meals make daily life noticeably better.
Understanding your body's automatic systems is the first step toward protecting them. If you're exploring related conditions, our guide to asthma explains another condition where nerve and airway responses shape daily symptoms.
Was this guide helpful? Leave a comment below with your experience or questions.
This article is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for medical decisions.
Related Reading
QSART Test: How Sweat Testing Checks Your Autonomic Nerves explains the sweat test that checks the small nerves of the autonomic system.
References
Mayo Clinic Staff. Autonomic neuropathy — Symptoms and causes. Mayo Clinic. July 7, 2022. https://www.mayoclinic.org/diseases-conditions/autonomic-neuropathy/symptoms-causes/syc-20369829
Mayo Clinic Staff. Autonomic neuropathy — Diagnosis and treatment. Mayo Clinic. July 7, 2022. https://www.mayoclinic.org/diseases-conditions/autonomic-neuropathy/diagnosis-treatment/drc-20369836
Chowdhury M, Nevitt S, Eleftheriadou A, et al. Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis. BMJ Open Diabetes Res Care. 2021;9(2):e002480. PMID 34969689. https://doi.org/10.1136/bmjdrc-2021-002480
Martin CL, Albers JW, Pop-Busui R, et al. Neuropathy and related findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study. Diabetes Care. 2014;37(1):31-38. PMID 24356595. https://doi.org/10.2337/dc13-2114
Kim MJ, Farrell J. Orthostatic hypotension: a practical approach. Am Fam Physician. 2022;105(1):39-49. PMID 35029940. https://pubmed.ncbi.nlm.nih.gov/35029940/
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