Your body regulates your temperature through the skin. Sweating is one way to decrease your body temperature when you get too hot. Your body does this automatically through the sudomotor nerves, which control where and how much you sweat. If you have neuropathy, these nerves may become damaged. Many people with autonomic neuropathy are unable to sweat through the hands and feet, but sweat excessively through the face and trunk. This may be because your body needs to get rid of excess heat. When the peripheral nerves to the arms and legs are damaged, you don’t sweat there. Instead, your body sweats more in the face and trunk to make up for the loss of sweating in the arms and legs
When the sudomotor nerves are damaged, you may notice an excessive amount of sweating in your face and on the trunk of your body. You may also notice that you sweat more when you eat certain foods, such as spicy dishes, cheese, chocolate, red sausage, red wine and even some soft drinks.
You may be less aware that you are sweating as much in your hands and feet. However, you may notice that the skin on your hands and feet is especially dry and that your hands and feet may be colder than normal. Your skin may also thicken on your feet and hands and be more likely to crack and develop infections.
What You Should Do
If autonomic neuropathy affects your pattern of sweating, you should talk to your doctor about ways to minimize the symptoms. Avoid extremes of heat and humidity, because your body has a difficult time regulating your body temperature. To treat your dry skin, it is important to use creams and lubrication oils to help retain moisture. Keep on the lookout for any cracks or lesions in the skin. You may need to apply an antibacterial ointment to keep an infection from developing. If your sweating is severe, your doctor may prescribe one of several drugs to help alleviate the problem, such as propantheline, hydrobromide, scopolamine patches or a cholinergic blocker.
One serious complication of autonomic neuropathy is hypoglycemia unawareness. When your blood glucose levels get too low, your body releases hormones that cause the liver to release more glucose. Your body also sends out messages that your blood glucose is too low. These signs of hypoglycemia, triggered by the release of the hormone epinephrine, include heart palpitations, irregular heartbeat, anxiety, shakiness and tingling in the mouth.
When you have hypoglycemia unawareness, you no longer can detect the symptoms of hypoglycemia. The only signs that hypoglycemia may be occurring are the effects of low blood sugar on the brain: irritability, tiredness, confusion, forgetfulness, and loss of consciousness. Unfortunately, these effects make it even less likely that you will notice that you have hypoglycemia. The normal warning signs of hypoglycemia—sweating, palpitations, shakiness, anxiety and tingling sensation in your fingers or toes—are absent or diminished. The longer you have diabetes, the more likely you are to develop hypoglycemia unawareness.
What You Should Do
If you suspect you have hypoglycemia unawareness, talk to your doctor about the best way to treat it. Practicing intensive therapy, for example, can reduce the risk of neuropathy that triggers hypoglycemia, but it can also increase the risk of hypoglycemia because you are practicing such tight control.
The best way to deal with hypoglycemia unawareness is to test your blood glucose level frequently, especially before meals, before exercising, before bedtime, and before driving a vehicle. If your blood glucose levels are low, you may need to eat more with your meal or have an extra snack. Keep a fast-acting carbohydrate snack with you at all times.
Make sure those around you know how to recognize the warning signs of hypoglycemia. They may be able to notice signals of which you are unaware, such as irritability, confusion and forgetfulness. Make sure your companions know how to administer glucagon and know when to call for emergency help. Make sure you wear a tag or bracelet that identifies you as having diabetes so that those around you will know to call for emergency help.
If your hypoglycemia unawareness is especially frequent, you may want to consider adjusting your blood glucose goals. Talk to your doctor about what goals are best for you.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Autonomic Neuropathy by Jennifer Dineen and Roy Freeman