Presentation is dependent on the type of neuropathy being dealt with [6].

Peripheral neuropathy

• Numbness or reduced ability to feel pain or changes in temperature, especially in the feet and toes
• A tingling or burning sensation
• Sharp, jabbing pain that often worsens at night
• Pain when walking
• Extreme sensitivity to the lightest touch 
• Muscle weakness and difficulty walking
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain

Autonomic neuropathy

• A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
• Bladder problems, including frequent urinary tract infections or urinary incontinence
• Constipation, uncontrolled diarrhea or a combination of the two
• Slow stomach emptying (gastroparesis), leading to nausea, vomiting and loss of appetite
• Difficulty swallowing
• Erectile dysfunction in men
• Vaginal dryness and other sexual difficulties in women
• Increased or decreased sweating
• Inability of the body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure following rise from sitting or lying down (orthostatic hypotension). This may cause the feeling of lightheaded and even fainting in some cases. 
• Problems regulating body temperature
• Changes in the way eyes adjust from light to dark
• Increased heart rate when at rest

Radiculoplexus neuropathy

• Sudden, severe pain in hip and thigh or buttock
• Eventual weak and atrophied thigh muscles
• Difficulty rising from a sitting position
• Abdominal swelling, if the abdomen is affected
• Weight loss

Mononeuropathy

• Difficulty focusing the eyes, double vision or aching behind one eye
• Paralysis on one side of your face (Bell's palsy)
• Pain in the shin or foot
• Pain in the front of the thigh
• Chest or abdominal pain

• Impaired Balance

  […] presence of DN may impair the balance in the affected patients. [ncbi.nlm.nih.gov]

• Nausea

  Erythromycin, domperidone (Motilium), or metoclopramide (Reglan) may help with nausea and vomiting. Pain medications (analgesics) may work for some patients on a short-term basis, but in most cases they do not provide much benefit. [web.archive.org]

  Consider gastric emptying studiesif the individual has persistent nausea/vomiting. [nhshighland.scot.nhs.uk]

  Symptoms may include Numbness in your hands, legs, or feet Shooting pains, burning, or tingling Nausea, vomiting, constipation, or diarrhea Problems with sexual function Urinary problems Dizziness when you change positions quickly Your doctor will diagnose [nlm.nih.gov]

  In blood vessels: Symptoms include: Blacking out when you stand up quickly Faster heartbeat Dizziness Low blood pressure Nausea Vomiting Feeling full sooner than normal If you have it: Avoid standing up too quickly. [webmd.com]

  Peppermint and ginger can stop the nausea induced by cayenne if it is still a problem. In addition, cayenne is a laxative. Once your body adapts to cayenne, the laxative effect will stop. [earthclinic.com]

• Diarrhea

  Diarrhea or constipation. You may have diarrhea if the nerves that control your small intestine are damaged. The diarrhea is most common at night. You may also have constipation as a result of damage to nerves in the intestines. [urmc.rochester.edu]

  Symptoms may include Numbness in your hands, legs, or feet Shooting pains, burning, or tingling Nausea, vomiting, constipation, or diarrhea Problems with sexual function Urinary problems Dizziness when you change positions quickly Your doctor will diagnose [nlm.nih.gov]

  Diarrhea associated with autonomic neuropathy has occasionally responded to broad-spectrum antibiotic therapy, although it often undergoes spontaneous remission. [health.am]

  Gastrointestinal Diarrhea may happen when the nerves that control the small intestine are damaged. The diarrhea happens mostly at night. Constipation is another result of damage to nerves in the intestines. Sometimes, the stomach is also affected. [muschealth.staywellsolutionsonline.com]

• Dyspepsia

  Symptoms such as anorexia, nausea, vomiting, and dyspepsia are nonspecific and resemble many other conditions ( 186 ) and may just be associated with the presence of diabetes ( 181 ). [doi.org]

  In clinical trials, only a few adverse effects have been reported - transient mild headache, flushing, dyspepsia, and some altered color vision. [health.am]

• Abdominal Distension

  Abdominal distension. Dysphagia. Diarrhoea. Gustatory sweating, anhidrosis. Tends to be associated with peripheral neuropathy. People with both types 1 and 2 are affected. [patient.info]

• Abdominal Bloating

  People with diabetes may present with early satiety; feeling of fullness; abdominal bloating or upper abdominal pain and discomfort. Consider gastroscopy if possibility of alternative cause for obstructive symptoms. [nhshighland.scot.nhs.uk]

• Hypotension

  Therapy with fluoxetine did not result in exacerbation of the orthostatic hypotension. [ncbi.nlm.nih.gov]

  When managing the symptoms of autonomic neuropathy, include standard interventions for the manifestations encountered (eg, abnormal sweating and postural hypotension). [patient.info]

  Orthostatic hypotension is usually easy to document in the office. In most cases of CAN, there is no compensatory increase in the heart rate, despite hypotension ( 173 ). [doi.org]

• Orthostatic Hypotension

  Therapy with fluoxetine did not result in exacerbation of the orthostatic hypotension. [ncbi.nlm.nih.gov]

  Symptomatic Treatment of Orthostatic Hypotension. Treatment for orthostatic hypotension is challenging and usually involves both pharmacological and nonpharmacological interventions. [doi.org]

  hypotension and decreased heart-rate variability, and CAN may contribute to left ventricular dysfunction, silent or asymptomatic myocardial infarction, and exercise intolerance. [1,13,14,15] There is evidence that the disease process may begin early [medscape.com]

• Tachycardia

  He was diagnosed with postural orthostatic tachycardia syndrome (POTS), and orthostatic intolerance disappeared after β-blocker treatment. Scintigraphy using 123I-metaiodobenzylguanidine showed decreased cardiac uptake. [ncbi.nlm.nih.gov]

  It may present with: Cardiac autonomic neuropathy, which has been linked to [ 5 ] : Resting tachycardia, postural hypotension, orthostatic bradycardia and orthostatic tachycardia. Exercise intolerance. Decreased hypoxia-induced respiratory drive. [patient.info]

  It can also strike your autonomic nervous system—the nerves that control heart rate, digestion and other essential functions—and lead to significant resting tachycardia (a heart rate that is higher than normal when you are at rest), slowing of the digestive [footsmart.com]

• Fracture

  This may impair daily living activities and increase the risk of falls and fractures.2 Nerve damage from diabetic neuropathy also greatly increases the risks of joint dislocations and stress fractures to bone. [podiatrytoday.com]

  ‘brain speed’ may matter more than other risk factors for geriatric falls "Why does a 30-year-old hit their foot against the curb in the parking lot and take a half step and recover, whereas a 71-year-old falls and an 82-year-old falls awkwardly and fractures [news-medical.net]

  Similar to a bunion this is corrected by either shaving off a portion of the metatarsal or creating a surgical fracture and realigning the bone. In most instances the patient is allowed to walk in a surgical shoe following surgery. [podiatrynetwork.com]

  Sometimes application of contact casting (a special form of cast not unlike what is used to treat a fracture, except it is better padded inside) can promote ulcer healing, again by reducing pressure on the ulcer. [sydney.edu.au]

  Charcot joint is also called neuropathic arthropathy and occurs when the bones in the feet fracture or "powder" and the foot becomes misaligned. [joslin.org]

• Muscle Cramp

  Symptoms Digestive tract: Constipation Diarrhea Nausea and vomiting Swallowing difficulty Legs and arms: Deep pain, most commonly in the feet and legs Loss of the sense of warm or cold Muscle cramps Numbness (if the nerves are severely damaged, you may [web.archive.org]

  “Physical therapy is used to alleviate many sources of pain, including neuropathic pain, muscle cramps, osteoarthritis, fibromyalgia, chronic headaches, rheumatoid arthritis, hamstring pain, back, shoulder and neck pain, just to name a few,” says Dave [salonpas.us]

  Symptoms of DPN include: Pain Burning, stabbing or electric-shock sensations Numbness (loss of feeling) Tingling Muscle weakness Poor coordination Muscle cramping and/or twitching Insensitivity to pain and/or temperature Extreme sensitivity to even the [endocrineweb.com]

  It may also help alleviate: burning and tingling sensations in the legs and feet muscle cramps muscle weakness sexual dysfunction Electrical nerve stimulation is a painless type of physical therapy that might help to reduce feelings of stiffness and enhance [medicalnewstoday.com]

• Diplopia

  The patient with cranial nerve involvement usually has diplopia and single third, fourth, or sixth nerve weakness on examination but the pupil is spared. A full recovery of function occurs in 6-12 weeks. [health.am]

  The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or periorbital pain and then diplopia. [en.wikipedia.org]

  Cranial nerve III involvement results in ophthalmoplegia, ptosis, and diplopia with sparing of pupillary function. The median, radial, and lateral popliteal nerves are the most common sites of peripheral nerve involvement. [aafp.org]

• Blister

  The study is based on suction skin blister specimens from the right foot of 32 healthy subjects and eight subjects with mild diabetic neuropathy. [ncbi.nlm.nih.gov]

  When sensory nerves in the feet become damaged, a blister, cut, or sore can go unnoticed, allowing time for the wound to become infected. [health.harvard.edu]

  A blister can become something more serious People should check regularly for blisters and other small skin wounds, as peripheral neuropathy can make them hard to notice and they can become ulcerated. [medicalnewstoday.com]

  These things could rub against your feet and cause blisters or sores. Treatment Diabetic neuropathy treatment There is no cure for diabetic neuropathy. Treatment focuses on slowing the development of the condition. [familydoctor.org]

• Dry Skin

  The common findings on physical examination were dry skin/callus (38.7%) and deformities (14.7%). [ncbi.nlm.nih.gov]

  The exam may find that you have the following: No reflexes or weak reflexes in the ankle Loss of feeling in the feet (this is checked with a brush-like instrument called a monofilament) Changes in the skin, including dry skin, hair loss, and thick or [nlm.nih.gov]

  Because one of the signs of neuropathy is a loss of feeling, feet should be checked daily for cuts, sores, blisters, bruises and cracked or dry skin. If you notice anything unusual, get to your doctor as soon as possible. [diabetes.co.uk]

• Anhidrosis

  Hypotension (symptomatic in up to 12%) Resting tachycardia or loss of sinus arrythmia (up to 20%) Dysphagia with delayed gastric emptying, nausea/vomiting Constipation/diarrhoea Urinary retention/overflow incontinence Neuropathic oedema Gustatory sweating Anhidrosis [nhshighland.scot.nhs.uk]

  Gustatory sweating, anhidrosis. Tends to be associated with peripheral neuropathy. People with both types 1 and 2 are affected. High mortality rate (50% within three years) mainly due to chronic kidney disease but there is often no obvious cause. [patient.info]

  […] and fainting sexual dysfunction, erectile dysfunction in men, and problems with vaginal lubrication and arousal in women changes in perspiration, heavy night sweating, the inability to regulate internal temperature or complete lack of perspiration ( anhidrosis [draxe.com]

  Too little or no sweating at all (anhidrosis) can be life-threatening. Prevention You can prevent or delay diabetic neuropathy and its complications by keeping tight control of your blood sugar and taking good care of your feet. [drugs.com]

• Skin Ulcer

  In patient 1, verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) and a diabetic skin ulcer developed simultaneously. In patient 2, VSLDN preceded the development of diabetic ulcers, while in patient 3, diabetic ulcers preceded VSLDN. [ncbi.nlm.nih.gov]

  The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. [foothealthfacts.org]

  Symptoms of DPN include: Pain, tingling, and burning Numbness and loss of feeling Muscle weakness Skin ulcers (open sores) About half of people who have DPN might not have symptoms, except for losing feeling in their feet. [hormone.org]

• Hyperhidrosis

  This can lead to anhydrosis, also known as reduced sweating, or hyperhidrosis, also known as excess sweating. This can lead to difficulties regulating body temperature. [healthline.com]

  Diabetic neuropathy also can cause motor deficits, silent cardiac ischemia, orthostatic hypotension, vasomotor instability, hyperhidrosis, gastroparesis, bladder dysfunction, and sexual dysfunction. [aafp.org]

  Incompetence of anal sphincter or Reduced rectal sensation Exacerbated by diarrhea Sudomotor syndromes Hypohidrosis Loss of thermoregulatory sweating Initially distal: Glove-stocking distribution May become diffuse: With more severe autonomic neuropathies Hyperhidrosis [neuromuscular.wustl.edu]

• Giddiness

  […] constipation or both; indigestion, nausea and vomiting; difficulty swallowing; loss of bladder control; changes in vision; erectile dysfunction and problems with ejaculation; vaginal dryness and sexual dysfunction; low blood pressure when standing up (causing giddiness [mydr.com.au]

• Vaginal Dryness

  dryness or orgasm problems in women. [nlm.nih.gov]

  If you have vaginal dryness, your doctor may suggest a lubricant. If you have erectile dysfunction, they may prescribe medication that can help. [healthline.com]

  Sexual problems, such as erection problems in men and vaginal dryness in women. Heart and blood vessel problems, leading to poor circulation or low blood pressure. [uofmhealth.org]

• Sexual Dysfunction

  In diabetic autonomic neuropathy, the patients may experience persistent nausea, vomiting, diarrhea, constipation, incontinence, sweating abnormalities or sexual dysfunction. [hopkinsmedicine.org]

  Symptoms of autonomic nerve dysfunction include:> erectile or sexual dysfunction loss of bladder or bowel control abnormal sweating with inability to tolerate changes in temperature abnormal blood pressure control, causing lightheadedness when standing [healthcentral.com]

  Female sexual dysfunction may manifest as diminished libido as a result of vaginal dryness and pain during intercourse (dyspareunia). [16,17] Neurogenic bladder or cystopathy may also be caused by diabetic autonomic neuropathy and can result in the inability [medscape.com]

• Urinary Incontinence

  For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence. [medicinenet.com]

  […] tract infections or urinary incontinence Constipation, uncontrolled diarrhea or a combination of the two Slow stomach emptying (gastroparesis), leading to nausea, vomiting and loss of appetite Difficulty swallowing Erectile dysfunction in men Vaginal [symptoma.com]

  The urinary tract may also be affected, and at the worst stages this can cause urinary incontinence. Also, neuropathy can decrease sexual response in both men and women. [diabetes.co.uk]

The condition is diagnosed based on symptoms presented, a physical exam and a medical history [7]. During the exam, the muscle strength and tone is checked, tendon reflexes as well as sensitivity to touch, temperature and vibration are also checked. Other tests that may be conducted include the following:

• Filament test
• Nerve conduction studies
• Electromyography (EMG)
• Quantitative sensory testing
• Autonomic testing

Diabetic neuropathy has no known cure [8] [9]. Treatment and management is mostly focused on slowing of the progression of the disease, relieving of pain, management of complications and restoration of functions.

Prognosis of diabetic neuropathy is an uphill task as it remains silent for several years after the onset of diabetes. [ncbi.nlm.nih.gov]

Expectations (prognosis) Treatment relieves pain and can control some symptoms, but the disease generally continues to get worse. [web.archive.org]

Prognosis of Diabetic Neuropathy The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. Treating diabetes may halt progression and improve symptoms of the neuropathy, but recovery is slow. [sydneynorthneurology.com.au]

More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis, according to the National Institute of Neurological Disorders and Stroke. [practicalpainmanagement.com]

There are certain risk factors associated with more severe cases of diabetic neuropathy. They include the following [2]:

• Poor glycemic control
• Advanced age
• Hypertension
• Long duration of diabetes mellitus
• Dyslipidemia
• Smoking
• Heavy alcohol intake
• HLA-DR3/4 phenotype
• Tall height

Development of symptoms is however, dependent on a variety of factors such as the total hyperglycemic exposure as well as other risk factors like elevated lipds, blood pressure, smoking, increased height as well as excessive exposure to some other neurotoxic agents like ethanol. Genetic factors have also be considered to have a role.

In the United States, 47% of patients with diabetes show some peripheral neuropathy [3]. Neuropathy is believed to be seen in 7.5% of patients at the time of diagnosis of diabetes with more than half of the cases demonstrating distal symmetric polyneuropathy. Internationally, figures are far lower.

Diabetes mellitus affects men and women with the same frequency. However, male patients with type 2 diabetes may develop polyneuropathy much earlier than their female counterparts. Diabetic neuropathy can be seen at any age but it is most common with increasing age, severity and duration of the diabetes.

The major factors responsible for the development of diabetic neuropathy remains incompletely understood [4]. However, multiple hypotheses have been brought forward. It is generally believed that the condition is a multifactorial process.

Development of symptoms is dependent on several factors such as total hyperglycemic exposure and other risk factors like elevated lipids, blood pressure, smoking, increased height, as well as high exposure to other potentially neurotoxic agents like ethanol. Genetic factors can also play a role.

Important contributing biochemical mechanisms in the development of the more commonly known symmetrical forms of diabetic polyneuropathy may include the following: polyol pathway, advanced glycation end products as well as oxidative stress.

Prevention Tight control of blood sugar levels may prevent neuropathy in many people with type 1 diabetes, and may reduce the severity of symptoms. In addition, regular foot care can prevent a small infection from getting worse. [web.archive.org]

Both primary prevention and secondary prevention (subjects with a history of previous foot ulcers) were considered. [doi.org]

No single treatment exists to prevent or reverse neuropathic changes or to provide total pain relief. [ncbi.nlm.nih.gov]

Diabetic neuropathies refer to any of the neuropathic disorders that are commonly associated with diabetes mellitus [1]. These conditions are believed to arise mostly from diabetic microvascular injuries which often involve the small blood vessels responsible for supplying nerves as well as macrovascular conditions that may end up in diabetic neuropathy. There are 4 major types of neuropathy: Peripheral neuropathy, autonomic neuropathy, radiculoplexus neuropathy or diabetic amyotrophy and mononeuropathy.

Diabetic neuropath refers to a type of nerve damage which can occur in people with diabetes. High blood sugar may bring about injury to the nerve fibres around the body but diabetic neuropathy is focused on the legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain, to numbness in the extremities as well as problems in the urinary tract, digestive tract, blood vessels and the heart. For some people, these symptoms are often mild while for others, diabetic neuropathy can be fatal, painful or disabling.

Diabetic neuropathy is common but serious complication of diabetes that can only be controlled by sticking to prescribed blood sugar controls and living a healthy lifestyle.