Do people with type 2 diabetes, especially those on insulin and those with insulin resistance, develop autonomic dysfunction (sympathetic) at any stage? If yes, please tell more about it.

Patients do develop autonomic dysfunction with diabetes. As is typical of autonomic dysfunction, whether in patients with type 1 or type 2 diabetes, its onset is generally years after having diabetes. It usually presents after distal symmetrical polyneuropathy. Patients usually have a diabetes duration greater than 10 years. The most common forms include cardiac involvement, hypoglycemia unawareness with inability to respond to low blood sugars, abnormalities of local blood flow leading to breakdown within the feet, bladder dysfunction, and gut involvement with gastroparesis and diabetic diarrhea. Parasympathetic/sympathetic balance is generally off. For instance, there is usually loss of cholinergic parasympathetic input first with resting tachycardia. These patients are then at risk for sudden death related to cardiac dysrhythmias.

JTL