Polyneuropathy (Distal Symmetric Neuropathy)
Common Health Issues

Polyneuropathy (Distal Symmetric Neuropathy)

Polyneuropathy is the most common type of neuropathy found in people with diabetes. It can affect as many as three-quarters of all people with diabetes. You may hear people referring to it by a variety of names: peripheral neuropathy, polyneuropathy, diffuse neuropathy, distal symmetric neuropathy, sensorimotor neuropathy, or painful neuropathy. This kind of neuropath can affect the nerves in many parts of your body. You might feel numbness, pain or loss of sensitivity in your arms, hands, legs or feet on both sides of your body. Although technically peripheral neuropathy refers to any kind of neuropathy that affects the peripheral nervous system, when people say they have peripheral neuropathy, this is often what they mean.

POLYNEUROPATHY SYMPTOMS

If you have polyneuropathy you may feel one or more of an array of symptoms, depending on what nerves are damaged and the extent of the damage. Nerves are made up of both small and large nerve fibers. If the small nerve fibers are damaged, you may feel symptoms that include a tingling or burning feeling, sensation of ‘pins and needles,’ pain in your arms and/or legs that is usually worse at night, a numbness or loss of feeling in your extremities, cold hands or feet, and swelling, especially in your feet. You may lose the ability to detect temperature. 

If the large nerve fibers are damaged, you may find that you lose your balance easily, are unable to sense the position of your feet and toes, and develop unusual sensations in your extremities. You could also develop Charcot’s joints, a condition marked by redness and swelling in your foot. If your motor nerves (the nerves that control your muscles) are damaged, you could lose muscle tone in your hands and feet, develop calluses and open sores on your feet, or develop misshapen or deformed toes and feet.

What You Should Do

If you are experiencing the pain of neuropathy, tell your doctor. Depending on the symptoms and the extent of the neuropathy, your doctor may suggest exercises that can help reduce the pain, or if the pain is especially severe, your doctor may prescribe a medication to provide some relief. You may also want to take steps to maintain tighter control of your blood glucose levels. If you keep your blood glucose levels as close to normal as possible, you may find that some of your symptoms will disappear. However, some symptoms, even with good glucose control, can persist for 6 to 18 months.

 

If you do have symptoms of neuropathy, your doctor may want to conduct some tests to accurately diagnose the problem. Neuropathy is often diagnosed by excluding other conditions that could result in the same symptoms. Your doctor will probably test your reflexes. Your doctor may also place a tuning fork against your toe to see whether you can detect vibrations. Your doctor may also place a monofilament wire against the fleshy part of your foot to see if you can detect the sensation of touch. If you have neuropathy, your body may not respond to these stimuli.

 

Your doctor may then send you to a neurologist for a more complete assessment of nerve damage. Your neurologist may elect to conduct an electromyogram to assess nerve function or a neurological exam to determine the severity of your neuropathy.

 

If you do have neuropathy, it is important that both you and your doctor be aware of it, even if you are not in great pain. This is because the most serious symptom of neuropathy is the loss of sensation, particularly in the feet. Pain signals you that something is hurting you or damaging your body. Without pain, you may not know that you have injured your foot, for example, and may continue to use it and damage it further. This could lead to ulceration, infection, gangrene and even amputation.

 

If you have neuropathy or suspect neuropathy, check your feet every day or have a friend or relative do it for you. Make sure to look at the top of your foot, the bottom of your foot, and between your toes. Any signs of irritation or ulceration should be treated right away. Protect your feet from any sort of injury or damage by wearing the proper shoes, not going barefoot, and inspecting them daily. Your doctor or diabetes educator can show you what to look for and how to examine your feet, as well as how to properly care for them.

If you smoke, stop smoking. Talk to your doctor about medical and social interventions if you are having a hard time quitting. Smoking only increases the likelihood of further nerve damage. Avoid alcohol, because it also increases nerve damage. If you have a problem curtailing alcohol intake, talk to your doctor about programs to help you.

 

Your doctor may also refer you to an exercise physiologist or suggest a program of walking, exercise or gentle stretching. Some people find yoga especially helpful. Biofeedback techniques and hypnosis have helped some people deal with neuropathy pain and may be worth a try. If your skin is especially sensitive, you may want to try an elastic body stocking, panty hose, or foot cradles to help keep clothes and bed covers from irritating your skin. If you have foot problems, lamb’s wool or orthotics fitted to your foot can help relieve pressure on your feet.

 

POLYNEUROPATHY TREATMENT

If you have taken steps to maintain control of blood glucose levels and have quit smoking and drinking but pain and other symptoms persist, your doctor may want to prescribe or suggest certain medications. For example, over-the-counter pain relievers and a capsaicin ointment (0.075%) applied to the skin may help relieve pain. Vitamins, although important as part of a balanced diet, do not usually help alleviate the symptoms of neuropathy. Painkillers that contain narcotics are not recommended for people with diabetes because of the side effects and potential addictions.

Other medicines, such as low doses of anticonvulsive agents (phenytoin, caramazepine or gabapentin) or antidepressants (amitriptyline, for example) may also relieve some of the symptoms of neuropathy. Antidepressants may also be prescribed alone or along with anticonvulsive agent. If you do try any of these medicines, give them time to see if they work. It may take as long as 4 to 6 weeks before they take effect, so make sure to give them fair trial. If you experience any side effects from the drugs, however, make sure to tell your physician right away. Common side effects include sleepiness, dry mouth, constipations, nausea and dizziness. These are often relieved by taking your dose at bedtime.

 

Another approach is to use a small battery-powered device known as a transcutaneous electrical nerve stimulation (TENS) unit. This device provides small electric impulses that block the transmission of pain messages to your brain and provide some relief from pain. This device must be prescribed by your doctor. Some people also find relief from acupuncture and acupressure. Ask your health care team about these methods and any other remedy you may have heard about. Some unorthodox methods actually do have some scientific validity, but others may be a waste of your time and money

 

POLYNEUROPATHY PREVENTION

The best way to prevent neuropathy is to keep tight control of your blood glucose levels. The Diabetes Control and Complications Trial (DCCT), as well as several other studies in other countries, have shown that keeping your blood glucose levels as close to normal as possible can reduce the incidence of neuropathy by as much as 60% in people with type 1 or type 2 diabetes. If you have type 2 diabetes and are overweight, losing weight can reduce insulin resistance and in turn reduce the risk of neuropathy. If you smoke, stop smoking and if you drink alcohol, reduce your alcohol intake. The more preventive steps you can take, the more likely you will reduce the risk of neuropathy now and in the future

Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

Diabetic polyneuropathy: an update by Douglas Zochodne 

Emerging Biomarkers, Tools, and Treatments for Diabetic Polyneuropathy by C Herder, A Strom et al 

Neuropathy and Diabetic Foot Syndrome by M Volmer-Thole and R Lobmann

Transcutaneous Electrical Nerve Stimulation in Relieving Neuropathic Pain: Basic Mechanisms and Clinical Applications by T Mokhtari, N Li et al 

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Rich Health Editorial Team

Health Research

Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner