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Question:

From Michigan, USA:

I am 32 years old and was diagnosed with Type 1 diabetes when I was l7. Over the years I have had all the usual complications of diabetes, i.e., retinopathy and neuropathy. The past few years I have been having a problem with low blood pressure or orthostatic hypotension. Is this a common problem among diabetics and is there anything that can be done about it?

Answer:

Orthostatic hypotension is a symptom of diabetic autonomic neuropathy and can be a problem in longstanding diabetic patients already affected by chronic diabetic complications. In this case, assumption of upright posture is followed by hypotension (drop in mean arterial pressure of more than 10 mm Hg) due to diminished sympathetic tone.

Treatment of postural hypotension involves awareness on the part of the patient and the need to change position slowly and of the potential hypotensive effect of insulin administration. In fact, insulin has been shown to produce direct cardiovascular effects due to arterial vasodilatation, a reduction in plasma volume and venous return. This can increase heart rate and simulate hypoglycemia in an insulin treated patient. It may be necessary to use elastic stockings of the legs and/or to add mineralocorticoids such as fluorohydrocortisone to minimize symptoms and to avoid autonomic blocking drugs. Finding the proper treatment can be quite difficult and you'd better ask your diabetes team for help.

MS

Original posting 26 Feb 1998
Posted to Complications

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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