Hyperhidrosis of the upper body, often related to eating (gustatory sweating) and anhidrosis of the lower body, is a characteristic feature of autonomic neuropathy. Gustatory sweating accompanies the ingestion of certain foods, particularly spicy foods, and cheeses. Gustatory Sweating is more common than previously believed and topically applied glycopyrrolate (antimuscarinic compound) is very effective treatment in reducing both the severity and frequency (177) (181). Symptomatic relief can be obtained by avoiding the specific inciting food. Loss of lower body sweating can cause dry, brittle skin that cracks easily, predisposing one to ulcer formation that can lead to loss of the limb. Special attention must be paid to foot care.
Figure Screening, diagnosis, and treatment of diabetic autonomic neuropathy
Management of DN encompasses a wide variety of therapies. Treatment must be individualized in a manner that addresses the particular manifestation, underlying pathogenesis, of each patient's unique clinical presentation, without subjecting the patient to untoward medication effects. There are new areas being explored in an attempt to enhance blood flow via vasa nervorum, such as the Nutrinerve, prostacyclin analogue beraprost, blockade of thromboxane A2, and drugs that normalize Na/K-ATPase activity, such as cilostazol, a potent phosphodiesterase inhibitor, and α-lipoic acid. Some of them, however, have not reached the clinical area.