Peripheral neuropathy is a common complication of diabetes. The aetiology has been considered to be exclusively metabolic with disturbances in polyol and myo-inositol metabolism affecting nerve ATPase activity. However, there is increasing evidence for the operation of microvascular disease and nerve hypoxia in neuropathy and this may be of signal importance after the initial metabolic insult on the peripheral nerves. Primary prevention is at present not possible but adequate education, particularly about foot care, is of the greatest importance in the prevention of neuropathic ulceration. The management of neuropathic pain and ulceration is discussed. Major therapeutic advances must await a better understanding of all the factors involved in pathogenesis of neuropathy