Diabetic neuropathy is a common complication of diabetes mellitus, affecting about or more than half of patients with diabetes mellitus. Neuropathic pain or autonomic dysfunction accompanying diabetic neuropathy is one of the most challenging and troublesome problem in these patients. Neuropathic pain usually progresses to chronic retractable pain, leading to a significant negative impact on quality of life. Recent treatments focus on two ways, attenuating ascending pain delivering pathways or enhancing descending endogenous pain modulating systems. Tricyclic antidepressants, antiepileptic drugs, and serotonin noradrenaline reuptake inhibitors are included as a first line treatment. On the other hand, autonomic dysfunction results in a considerable morbidity. It also reduces physiological and psychological well-being and daily activities of the patients. It causes any organ problems including cardiovascular, sudomotor and thermoregulary, gastrointestinal, and urogenital dysfunction. Physicians should consider individual patient’s comorbidities and adverse effects of drugs when choosing medication. This lecture will summarize treatment guidelines for painful diabetic neuropathy and symptomatic management for diabetic autonomic neuropathy.