Distal polyneuropathies

Distal polyneuropathy: an introduction

Distal polyneuropathy is the most common type of neuropathy associated with diabetes. It involves abnormal sensation in the hands and feet (the term distal is from a Latin word that means away from the center and here refers to parts of the body that are outside of the chest and abdomen). Distal polyneuropathy (also called aperipheral neuropathy) can be dangerous because a person with nerve damage in the feet and hands may experience an injury, such as a burn or cut, and not be aware due to the loss sensation.

Is there a way to reduce my risk for polyneuropathy?

If you have diabetes, the most important step you can take steps to reduce your risk for polyneuropathy and other nerve complications is to control your blood sugar. High blood sugar is thought to directly cause damage to nerve cells that lead to polyneuropathy.1

There are several other factors that increase your risk for polyneuropathy. They include:

  • Heart disease
  • High triglycerides (a type of lipid)
  • Being obese or overweight (having a body mass index [BMI] between 25 and 29.9) or obese (having a BMI of 30 or higher)
  • Smoking
  • High blood pressure

The good news about diabetic neuropathy is that you can do a lot to lower your risk. First and foremost, control your blood sugar. But don’t stop there. You can make some other important healthy lifestyle changes that will lower your risk for neuropathy and other diabetes complications, including quitting smoking (if you smoke), losing excess weight and keeping it off, keeping your blood pressure and lipids under control, getting regular exercise of moderate intensity, and adopting an energy-appropriate, nutrient-dense, and culturally appropriate eating pattern.

A healthy eating pattern should be based on recommendations for the general public in the US Department of Agriculture’s Dietary Guidelines for American, 2010 and should include a high intake of fruits, vegetables, and dietary fiber and a low intake of total fat, saturated fat, and added sugars. For example, when it comes to carbohydrates, you should choose whole grains, legumes (peas and beans), vegetables, and fruits (especially those high in dietary fiber). For protein, animal- and plant-based source can be part of a healthy eating plan. However, some animal-based protein sources contain saturated fat, so low-fat, non-fat, or lean sources should be selected. For fats, monounsaturated and polyunsaturated fats, such as those found in seafood, nuts, seeds, and oils should be selected.2

Learn more about healthy lifestyle changes that you can make.

What are the signs and symptoms of polyneuropathy?

The signs and symptoms of distal polyneuropathy include1:

  • Pain (may be worst during rest and better during activity)
  • Numbness
  • Burning or tingling sensation
  • Extreme sensitivity to touch
  • Inability to feel light touch or determine the position of the foot
  • Decreased ability to sense pain and temperature
  • Weakness and loss of balance

The signs and symptoms of distal polyneuropathy typically affect both sides of the body and may appear first in the toes, progressing up the legs over time. If symptoms reach the mid-calves, they may also appear in the hands. If these symptoms persist for a long time, a person may lose the ability to sense pain, which increases the risk for injury.

Are there tests to detect polyneuropathy?

Diagnosis of polyneuropathy is typically made using medical history and close examination of the feet. More involved testing, including tests measuring nerve conduction velocity, imaging tests such as x-ray or computed tomography (CT) scan, or nerve biopsy are usually not required.1

Signs of nerve damage during physical exam may include:

  • Inability to sense vibration or movement in toes or feet
  • Loss of sensitivity to light touch and increased/decrease temperature in toes or feet
  • Loss of sensitivity to pain in toes or feet
  • Decreased Achilles tendon reflex

How is polyneuropathy treated?

While there is no cure for polyneuropathy, there are effective ways to control and improve pain and to decrease the risk for further complications. Treatment for polyneuropathy usually includes three approaches1:

  • Blood sugar control
  • Foot care to prevent complications
  • Pain control

Blood sugar control. . Controlling your blood sugar is one of the most important steps you can take to treat polyneuropathy. Talk to your doctor about how you can best control your blood sugar. If you are having trouble controlling your blood sugar with a healthy eating plan and exercise alone, talk to your healthcare provider about starting a blood glucose lowering medication. Many people who are diagnosed with type 2 diabetes start an oral blood glucose lowering medication after being diagnosed.

Foot care.. If you have polyneuropathy, and especially if you have loss of sensation in your feet, you should make monitoring and foot care a part of your daily routine. According to the American Diabetes Association Standards of Medical Care, people with diabetes should have a comprehensive examination of their feet once per year and a visual examination of their feet at each doctor’s visit (every 3 to 4 months). Here are some suggestions for what you can do to avoid foot complications that are increased by polyneuropathy1:

  • Monitor your feet regularly for changes in the skin and especially for wounds and cracks that can increase risk for infection
  • Keep your feet clean by washing them daily
  • Do not engage in activities that can result in foot injury (these include walking barefoot, use of a heating pad or other source of heat on the foot)
  • When trimming toe nails use care
  • Choose socks that fit loosely and change them every day
  • Make sure your shoes fit correctly to reduce the risk for blisters
  • Make sure your doctor gives you regular foot exams

Pain control. Nerve pain can be very difficult to control and can significantly reduce your quality of life. Fortunately, pain affects only a small percentage of people with diabetic neuropathy.

Several medication are available that may be useful in controlling pain related to diabetic neuropathy, including duloxetine (Cymbalta) and pregabalin (Lyrica), which are approved by the FDA specifically for this purpose.1

Other medications that may be useful in relieving pain include tricyclic antidepressants (amitriptyline, nortriptyline, and desipramine), anesthetic drugs (lidocaine), alpha-lipoic acid (a type of antioxidant medication), and narcotics (such as tramadol). If you are experiencing pain from polyneuropathy, talk to your doctor about your options for pain medications.1

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Written by: Jonathan Simmons | Last reviewed: May 2014.