Which distribution is most characteristic of diabetic polyneuropathy on exam?

Which distribution is most characteristic of diabetic polyneuropathy on exam?

• A. Stocking-glove distribution
• B. Focal mononeuropathy
• C. Proximal weakness
• D. Cranial neuropathy

Answer: (A)

Diabetic polyneuropathy is best understood as a length-dependent, symmetric axonal neuropathy. The longest nerves are affected first, so sensory symptoms start in the feet and then involve the hands in a stocking-glove pattern. On exam you’d expect diminished vibration and pinprick sensation in the distal toes and feet, with ankle reflexes often reduced early, and similar distal findings in the hands as it progresses. This distal, symmetric distribution distinguishes it from other patterns: a focal mononeuropathy would involve one nerve distribution rather than a symmetrical, distal pattern; proximal weakness points to a proximal myopathy or radiculopathy; cranial neuropathies affect a specific cranial nerve rather than a distal, length-dependent spread.

Diabetic polyneuropathy is best understood as a length-dependent, symmetric axonal neuropathy. The longest nerves are affected first, so sensory symptoms start in the feet and then involve the hands in a stocking-glove pattern. On exam you’d expect diminished vibration and pinprick sensation in the distal toes and feet, with ankle reflexes often reduced early, and similar distal findings in the hands as it progresses. This distal, symmetric distribution distinguishes it from other patterns: a focal mononeuropathy would involve one nerve distribution rather than a symmetrical, distal pattern; proximal weakness points to a proximal myopathy or radiculopathy; cranial neuropathies affect a specific cranial nerve rather than a distal, length-dependent spread.