Cardiac Autonomic Neuropathy in Type 1 Diabetes Mellitus: A Case Report

Cardiac Autonomic Neuropathy (CAN) is a well-recognized complication of diabetes mellitus that affects both type 1 and type 2 diabetic patients. Its clinical presentation can be subtle and early detection is of utmost importance for effective management and prevention of adverse cardiovascular outcomes. We report the case of a 25-year-old male with an 8-year history of type 1 diabetes who presented with dizziness, worse on standing, together with resting and orthostatic tachycardia. Several autonomic function tests have been described in literature to confirm the presence and severity of CAN. However, in an emergency medicine setting common causes of tachycardia (some of them quite critical) must be excluded before attributing tachycardia to autonomic dysfunction secondary to diabetes. That said, CAN must always be considered in diabetic patients with relevant clinical presentation as a rule-out diagnosis. This is particularly important in view of the detrimental cardiovascular sequelae for the patients. In addition, prompt diagnosis of CAN can have a significant impact on patient’s management by triggering optimization of their diabetic control and offering treatment that can alleviate their symptoms. CAN is an admittedly challenging complication of diabetes, with multi-factorial pathogenesis, and largely under-diagnosed with few cases in literature. Further research is needed to enhance our understanding of CAN and to develop early tools for effective diagnosis of diabetes complication. Thus, raising awareness among clinicians for this medical entity can prompt early consideration in our differentials and optimal treatment for the patients.