Clinical symptomatology and treatment of diabetic and alcoholic polyneuropathies

1. Big picture

Diabetic and alcoholic polyneuropathies are among the most common acquired chronic polyneuropathies. Both usually produce a distal symmetric length-dependent polyneuropathy, meaning the longest nerves are affected first. Therefore, symptoms begin in the feet and later may involve the hands.

The classic exam pattern is:

burning feet + paraesthesia + distal numbness + reduced ankle reflexes + stocking-glove sensory loss = polyneuropathy

The cause then guides treatment:

• Diabetes mellitus causes metabolic and microvascular nerve injury.

• Chronic alcoholism causes direct toxic nerve damage plus nutritional deficiency, especially **thiamine / vitamin B1 d