Symptoms that suggest neuropathy include pain, pins and needles, numbness, increased sensation to touch cramps weakness and difficulty with balance. These occur most commonly in the feet and hands, and progress to involve the entire limb. They can be present either during activity or quite commonly at rest.

About 7% of the population suffers from neuropathy and half have diabetes. Diabetes is the most common cause of peripheral neuropathy. In the United States, an estimated 17 million people have diabetes, although this is an underestimate since the disease remains undiagnosed in approximately half. Over 60% of diabetics will develop noticeable evidence of neuropathy and most diabetics will have variable forms during their lifetime.

Neuropathy may occur early in the disease during the stage of impaired glucose tolerance called prediabetes.

Disability caused by neuropathy is common in diabetes because of frequent severe burning pain. The most common cause of ulceration of the foot and amputation is diabetic neuropathy.

Another common form of peripheral nerve involvement seen mostly in long standing disease is autonomic neuropathy or dysfunction of the "involuntary" nerves. It may cause sweating disturbances (loss of sweat), low blood pressure, slowed digestion, diarrhea, bladder problems and cardiac arrhythmias. Erectile dysfunction is common, with impotence occurring in 20-60 % of diabetic men.

Diabetic neuropathies can also present with severe mid to low back pain, weakness and atrophy of the thigh muscles, paralysis of muscles in the face and profound weight loss associated with severe pain in the distal limbs and back , depression and impotence in men.

Compression of nerves in arms or legs is very common in diabetics, specially at the level of the wrist and ankle (carpal tunnel syndrome and tarsal tunnel syndrome). Nerves that travel through fibroosseous tunnels are more sensitive to compression. This problem can cause significant difficulties using the hands or walking.

Symptoms that resemble diabetic neuropathy can be seen in other conditions like HIV infection or the effect of multiple medications that are used in the treatment of cancer.

Pain in neuropathy is the most disabling symptom and requires special attention.

Several approaches to treat pain have been used with variable results.

Medication should be tried first. The drugs that may be effective in some cases include antidepressants, anticonvulsants and opiates or similar substances. Unfortunately their use is limited by significant side effects in many instances. Topical agents in the form of creams have also been tried.

Physical modalities include TENS units, ultrasound and lately, a form of infrared photo energy device applied to the skin of the painful area (monochromatic infrared energy or MIRE).

If these treatment approaches fail to relieve disabling symptoms, decompressive surgery can be performed. This involves releasing the pressure on the affected nerves. The most common areas of compression are the wrist (carpal tunnel syndrome), the ankle (tarsal tunnel syndrome), and other nerves in the arm and leg including the foot.

Relief or improvement in pain and restoration of sensation has been achieved in about 85% of cases (J Am Podiatr Med Assoc 95(5): 451-454, 2005).

Surgical decompression can also prevent serious complications of the foot like ulcerations and ultimately amputations.