Autonomic dysfunction (imbalance between sympathetic and parasympathetic systems) affects the gastro-intestinal tract, resulting in delayed gastric emptying, constipation or diarrhoea.
The impaired colonic motility causes stagnation of bowel contents and colonisation by pathogenic bacteria and infection. This diarrhoea responds to the antibiotic tetracycline but the mechanism is ill understood. Bladder dysfunction or impotence can occur.
Skin Disorders: Diabetic foot ulcers are a dreaded problem. The elevated blood sugar leads to altered and defective protein synthesis and abnormal collagen formation, and the tissue formed is easily susceptible to trauma.
Blockage to the minute blood vessels also causes ischaemic necrosis of the skin and gangrene can result with added infection. This leads to easy breakdown of skin and formation of ulcers; and, since the nerves are damaged, the pain is not noticed even if there is gross infection.
Healing of wounds is delayed due to poor circulation and low resistance of the tissues in a high sugar medium. The skin on the surface of the shin is affected by certain specific lesions. The deposition of lipid-laden macrophages on the buttocks, back of the elbows and knees constitute what are known as xanthomas.