Diabetic Autonomic Neuropathy (DAN) – Quick Reference Guide
System Main Problems Non-drug Measures Medications / Interventions
Cardiovascular ↑ Salt
Orthostatic hypotension
& fluids, compression stockings, elevate head of bed,Midodrine,
slow posture
Fludrocortisone,
changes Droxidopa, Pyridostigmine
Resting tachycardia / silent ischemia Low-dose β-blocker (if symptomatic), CV risk factor control
Avoid aggravating drugs, regular cardiac evaluation
Gastrointestinal Gastroparesis Small, frequent, low-fat/low-fiber
Metoclopramide,meals
Domperidone, Erythromycin (short-term), gastric stimulator/feeding tube
Diarrhea (nocturnal, painless) Rule out infection, dietary adjustmentsLoperamide, Clonidine, antibiotics (rifaximin) if SIBO
Constipation Hydration, ↑ dietary fiber, exercise Osmotic or stimulant laxatives
Genitourinary Neurogenic bladder Timed/double voiding, intermittent catheterization Bethanechol (rare)
Erectile dysfunction Lifestyle change, counseling
PDE-5 inhibitors (sildenafil, tadalafil), vacuum devices, injections, prosthesis
Female sexual dysfunction Counseling, lubricants Vaginal estrogen if postmenopausal
Sudomotor Anhidrosis (heat intolerance) Cooling measures, avoid overheating Symptomatic only
Gustatory sweating Avoid triggers Topical glycopyrrolate, oral anticholinergics
