A 59-year-old woman with type 2 diabetes reports dizziness when standing, early satiety, and occasional diarrhoea with significant blood pressure drop on standing. What is the most appropriate diagnosis?

• A. Peripheral neuropathy
• B. Autonomic neuropathy
• C. Nephropathy
• D. Cardiovascular disease

Answer: (B)

Autonomic neuropathy from diabetes best explains this pattern. When autonomic nerves are damaged, the body’s normal reflexes that regulate blood vessel constriction and heart rate in response to standing are blunted. This leads to orthostatic hypotension—a notable drop in blood pressure with standing that causes dizziness. Autonomic nerves also control GI motility, so gastroparesis can cause early satiety, and enteric neuropathy can contribute to diarrhoea. The combination of orthostatic symptoms plus GI involvement fits diabetic autonomic neuropathy rather than a purely peripheral neuropathy, nephropathy, or cardiovascular disease. Peripheral neuropathy would mainly cause sensory changes in the extremities; nephropathy centers on kidney-related problems; cardiovascular disease could cause some dizziness but wouldn’t typically present with this GI symptom cluster linked to autonomic dysfunction.