Use the time course first: neuropathy that evolves over days to weeks should be treated as urgent until proven otherwise. Diabetic polyneuropathy is usually symmetric, distal, and accompanied by ankle reflex loss.

Rapid escalation over days to weeks is a red flag; Fulminant immune neuropathy should prompt urgent hospitalization; Diabetic polyneuropathy is length-dependent and symmetric; Ankle reflexes are typically reduced early; Distal numbness and tingling are common