INS and Hyperglycemia: The pathophysiology behind diabetic neuropathy is not fully understood, but is thought to be multifactorial with contributions including hyperglycemia-induced vascular damage leading to neuronal hypoxic ischemia, hyperglycemia-activated pro-inflammatory pathways, impaired insulin function preventing neuronal repair and promoting neuronal death and neuronal damage secondary to advanced glycation end products and oxidative stress [43,44,45,46,47,48,49,50,51].