Not always. I don't have any autonomic symptoms and I've had PN over 30 yrs.

The ones with severe damage, from drugs, or autoimmune issues seem to get the autonomic effects. Long standing diabetics too. But it appears variable among patients.

You know not all diabetics get PN either, or if they do not always severely.
Not all diabetics progress with kidney or heart damage either. A recent study showed that certain genes predispose diabetics to faster deterioration than others.

There may be some genetic reason for the variability of PN among different people.

There are tests for autonomic PN...but usually you need to show symptoms to a doctor for that evaluation. They won't do them for just sensory symptoms as a rule.