Diabetic neuropathies (DN) are a heterogeneous group of disorders that include a wide range of abnormalities. They can be focal or diffuse, proximal or distal, affecting both peripheral and autonomic nervous systems, causing morbidity with significant impact on the quality of life of the person with diabetes, resulting in early mortality. Distal symmetric polyneuropathy, the most common form of DN, usually involves small and large nerve fibers. Small nerve fiber neuropathy often presents with pain without objective signs or electrophysiologic evidence of nerve damage. However, there are now measures enabling early recognition of this type of neuropathy as a component of the impaired glucose tolerance and metabolic syndromes. The greatest risk of small fiber neuropathy is foot ulceration and subsequent gangrene and amputation. Large nerve fiber neuropathies produce numbness, ataxia and incoordination, impairing activities of daily living and causing falls and fractures. A careful history and detailed physical examination is essential for the diagnosis. Symptomatic therapy has become available, and newer and better treatment modalities based on etiologic factors are being explored with potential for significant impact on morbidity and mortality. Preventive strategies and patient education still remain key factors in reducing complication rates and mortality. A number of mechanical measures for the treatment of neuropathy have been examined, and it is currently unclear whether or not these have salutary effects over and above those of placebo, and longer, well-controlled clinical trials are anticipated. In addition, there is the suggestion that surgical unentrapment of nerves in DN may confer symptomatic relief, but outside of clear applications in proven entrapments, this form of intervention has not been endorsed universally. We now have two drugs approved for the treatment of neuropathic pain in diabetes that is a first, and it remains to be seen whether the evidence-based approach will supersede the need for cost containment and the tried and tested approaches to pain management in the clinic. Finally, the American Diabetes Association have included somatic and autonomic guidelines in their 2006 issue of clinical recommendations, which has come as a welcome relief to the Cinderella of diabetic complications, DN.