NERVE INJURY TO HEART AND BLOOD VESSELS
The vagus nerve regulates the heart rate, and when it gets injured due to
high blood glucose levels the heart rate is fast even at rest. The fast heart rate by itself is not necessarily
harmful, unless the person also has coronary artery disease. In this case, the neuropathy can increase the risk
of serious heart rhythm problems and even death. Therefore, people with diabetes who have autonomic neuropathy
affecting the heart should be evaluated by a cardiologist to determine the extent of heart
disease.
The nerves to the heart and blood vessels regulate the blood pressure
changes that occur when getting up from a lying down position to sitting to standing. If these nerves are
injured, you can get light-headed on sitting up or on standing. This is because the blood pressure falls
(referred to as postural hypotension). It is a condition that can be quite difficult to treat satisfactorily.
The following interventions may help:
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Avoid getting dehydrated and increase fluid and salt
intake.
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Avoid lying completely flat and sleep either with the head
of the bed raised or in a sitting position. This reduces the blood pressure changes with
posture.
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Wear support stockings to reduce the blood pooling in the
legs.
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Take fludrocortisone (Florinef), a medicine that causes salt
retention. The problem is that although the drug helps raise blood pressure when sitting or
standing, it can also lead to high blood pressure when lying down, which is not such a good
thing.
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Take midodrine (ProAmatine), a newer treatment that
constricts the blood vessels and raises blood pressure—your doctor may prescribe this if the
other treatments are not effective.
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