Pre-Diabetic Autonomic Neuropathy

Hello. I’m Dr. Randall Gates; I’m a chiropractor as well as being a board-certified chiropractic neurologist. So, we work with a variety of neurologic conditions here, and pre-diabetic autonomic neuropathy is one of them. We basically have a large neuropathy practice. We have many other conditions which are fibromyalgia and chronic pain syndromes and balance disorders, but neuropathy is a big part of our practice, and many times, patients with pre-diabetes will have a painful small fiber and autonomic neuropathy. Now, today we’re talking about autonomic neuropathy so we’re going to go with that. We’ve already done one on pre-diabetic neuropathy. I recommend you watch it. Now, what is autonomic neuropathy?

With peripheral neuropathy, commonly a person will have numbness, tingling, and/or burning in their feet, and maybe their hands. There are many other types of neuropathies; we’re not going to get into the nuisances of those. With autonomic neuropathy, basically the nerves that control autonomic functions or automatic functions, like your pupils dilating or constricting, like you salivating, like your heart speeding up when you’re exercising, like you digesting your food, like you having an erection or you going into reproductive function, or you getting blood flow to your feet, all those things are controlled by these nerves that control automatic responses, and they’re termed the autonomic nerves. And, there’re two sides.

There’s the fight, fight response that repairs you to fight a bear that comes from your brain and sends signals throughout your body to do one thing versus rest and digest responses. Think of the lion sleeping under the tree for 20 hours after they make their kill. And so, what happens with pre-diabetes is that we get blood sugar elevations some of the time. Not all of the time as we commonly see in an unmanaged case of diabetes. But, if you have pre-diabetes, lots of times patients may be getting a little larger in the waist, maybe their blood pressure’s going up, maybe your cholesterol’s a little bit up, and your doctor runs an HBA1C, which is a 3-month measure of blood sugar, and says, ‘Hey, Joe,’ or ‘Hey, Sharon, your sugar’s starting to go up. You’re not diabetic yet but you’re moving that direction.’

And what that really means is that, when you eat a carbohydrate dense meal like a feast of pasta or a box of donuts, you can’t make enough insulin to get all that sugar back into yourselves. Insulin takes sugar from our blood stream, puts it into our cell. You can’t make enough insulin to do that. So as a result of that, your sugar keeps climbing, climbing, climbing, and in those instances, the sugar draws water into three primary tissues; the retina, the kidneys, and nerves. And because the autonomic nerves, as well as the small fiber nerves, because the autonomic nerves don’t have a lot of insulation around them, they can take on water really easily and swell, and therefore start to dysfunction pretty quickly.

And, just a little nerve physiology, we have big nerves and nerves like the sciatic nerve, those encode which direction your toes are going, small nerves encode pain and texture, autonomic nerves tend to encode exactly what I was talking about, blood flow parameters. It really depends on where the nerve is going, but definitely blood flow into the feet. So that’s why a lot of those with autonomic neuropathy may have blood flow issues into their feet. Maybe your feet turn red, maybe your feet turn purple, maybe they turn blue. But, oftentimes when someone develops autonomic neuropathy, they can have a host of complications throughout their body, like their heart rate may not change the way it’s supposed to when they’re under stress. Or, maybe they develop an arrhythmia.

There’s a possibility you may not be digesting your food as well as you should be. Maybe now if you’re a male, you’ve developed erectile dysfunction and you don’t know why. You’re taking Cialis. Well, oftentimes in a pre-diabetic state, it can be due to pre-diabetic autonomic neuropathy. And, I have a list of articles here, we’ll be happy to send them to you. Go to to request them. is really the best place to get them from. We’re not going to post them, that’s why I hesitated. Anyways, one of the articles talks about how in pre-diabetics, the pupil area response actually changes. So, if you shine a light into the eye, the pupil should constrict and it will dilate. And they’re showing that in pre-diabetics, that response will change because of pre-diabetic autonomic neuropathy.

So, I bring that up because that’s a far-reaching implication away from the feet, which a lot of people who are searching this are going to be concerned about. Know that there are ways to control pre-diabetes. Pre-diabetes is a problem of lifestyle as well as diet, and that is not a degenerative way of saying that at all. We have so many videos on really discussing the underlying roots of diabetes and blood sugar dysregulation. Now, a lot of it has eventually come from the gut, and there’s certain things in your diet that you may think are healthy that are not, that are actually provoking your pre-diabetes to continue or get worse. So, know that you can control your pre-diabetes and there’s a lot of research showing that, especially small fiber neuropathies, secondary to pre-diabetes, these changes can be reversed and you can be improved.

We also talked about in the small fiber pre-diabetic video, about how new studies are showing that nerves can be rehabilitated. We can actually shock nerves with certain types of electric stimulation and cause them to improve in their function for a short period of time. And we’re seeing clinically in the right selected patient that you can basically shock the nerve, and if you couple that with the metabolic intervention, this case corrective of pre-diabetes, we’re seeing some pretty neat results. So, for any other questions, contact us at We have a lot of other videos on our website, and we’ll go from there. Thank you for watching.

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