Treatment of Diabetic Neuropathy in Orthostatic Hypotension

This protocol applies to patients with diabetic neuropathy who develop orthostatic hypotension — a specific haemodynamic complication defined by a measurable drop in blood pressure on standing.

Clinical scenario: Orthostatic hypotension in a patient with diabetes — defined as a fall in systolic blood pressure >20 mmHg or diastolic blood pressure >10 mmHg upon standing.

Condition

Advanced diabetic neuropathy may be associated with orthostatic hypotension — a fall in systolic or diastolic blood pressure by >20 mmHg or >10 mmHg, respectively, upon standing, typically without an appropriate compensatory increase in heart rate.

Treatment Approach (partial)

Management includes measures targeting physical deconditioning and volume status. Both non-pharmacological strategies and selective pharmacological options play a role, with volume repletion as a central component of care. The complete structured regimen is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.2337/dc16-2042

Advanced disease may also be associated with orthostatic hypotension (a fall in systolic or diastolic blood pressure by >20 mmHg or >10 mmHg, respectively, upon standing without an appropriate increase in heart rate).

Physical activity and exercise should be encouraged to avoid deconditioning, which is known to exacerbate orthostatic intolerance.

Volume repletion with fluids and salt is central to the management of orthostatic hypotension.

Low-dose fludrocortisone may be beneficial in supplementing volume repletion in some patients, although there are growing concerns on risk of supine hypertension.

View source ↗