Diagnosis for Diabetic Autonomic Neuropathy

I have been insulin dependent diabetic for about 13 years.  My A1C normally is around 7.1-7.3%.  I have diastolic heart failure.  I am on Coreg, Accupril and Norvasc as well as Lipitor and Plavix.  Recently, I have been having episodes of bradycardia and hypotension.  One sent me to the ER but the cardiologist diagnosed it as reaction to a higher dose of Coreg that wasn't tolerated.  I recently have been having blurred vision, (comes and goes), both postural and nonpostural hypotension.  Last evening we got down to 70/40 but it resolved before I went to the ER.  

I am concerned about an episode when I am not in a well controlled enviornment and wondered if there is are tests that can confirm or deny this condition?  I am a patient at Ross Heart Hospital at The Ohio State University and expect they could perform the tests if available.

[Michael J. McWilliams, M.D.]

That is a clinical diagnosis.  I have not ordered any test to confirm this.  Other causes for hyoptension or orthostatic blood pressure changes (changes in blood pressure in different positions) are ruled out first.  An electrophysiologist is probably not the right place to turn for the diagnosis though, as this doesn't really have a heart rhythm problem associated with.  Blair Grubb at the U of Toledo is a syncope specialist and I believe sees a lot patient with autonomic symptoms as well.

I hope this helps.

[bobbyandnannan]

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