@jakedduck1 Interesting question - I've often thought about mine in relation to how it was progressing when I started paying attention back in 2016 and started taking supplements including R-ALA. My only gauge is that it hasn't gotten into my upper legs yet with the same feeling as my feet and toes. I think the only real way to tell is if you have a skin punch biopsy when you are diagnosed and then probably get another one sometime later to actually count the number of dead nerves. I never had one when I was diagnosed by a nerve conduction study along with exam and labs so not sure it would even help me learn if it's progressing now.

@jakedduck1 Oh, you'll know! My PN is definitely progressing. A year ago I could walk fairly well. Then about 6 months ago, I noticed that walking a straight line had become more difficult. Today, Walking takes all my concentration. I feel like I am going to fall with each step. A cane is on the horizon... unless I can exercise myself back to better balance.

@jakedduck1 Interesting question. In the great majority of cases, PN progresses though at different speeds. If you start R-ALA and it does not progress, is an indication to me that R-ALA is effective. My neurologist supports the use of R-ALA at a minimum rate of 600 mg per day.