Diabetic symmetrical distal neuropathy or diabetic polyneuropathy is the most common form of diabetic neuropathy and a leading cause of neuropathy in the United States. Complications include pain, loss of ambulation, and risk for amputation. Recognizing the typical pattern of presentation and risk factors for diabetic polyneuropathy is essential for making the correct diagnosis and determining appropriate workup and need for neurologic consultation. Intensive glucose control is the only therapy proven to prevent or slow the progression of diabetic polyneuropathy. Supportive therapies, including pain management and podiatric care, can improve quality of life and prevent chronic ulcerations.