Location
Philadelphia, PA
Start Date
30-4-2025 1:00 PM
End Date
30-4-2025 4:00 PM
Description
INTRODUCTION/BACKGROUND:
Treatment-induced neuropathy of diabetes (TIND) is a rare, iatrogenic small-fiber neuropathy caused by the rapid lowering of glucose levels in patients with previously poorly controlled diabetes. The prevalence of this condition remains undetermined as TIND remains an unrecognized complication of diabetes. In contrast to the classical sensory-motor polyneuropathy of diabetes, TIND is characterized by a more acute onset neuropathic pain. An important positive correlation exists between the magnitude and rate of change in HbA1c levels and the severity of symptoms. The more significant and rapid the decrease in HbA1c levels, the greater the intensity and distribution of neuropathic pain. This occurs independent of the agent used to correct the high HbA1c.
RESULTS:
A 50-year-old female with a significant history of poorly controlled type 2 diabetes mellitus (DM2) complicated by peripheral neuropathy presented to the ED following syncopal fall. During syncopal evaluation, the patient denied a prior history of stroke or seizures but reported long-standing orthostatic hypotension. A CT pan-scan revealed no acute processes. During the current admission, laboratory evaluations were unremarkable.
Per chart review, the patient previously presented with bilateral lower extremity weakness and paresthesias. A formal diagnosis of type II diabetes mellitus was made 5 months prior, when the patient’s HbA1c levels were reduced from 15.0 to 7.1. The patient was ultimately assigned a diagnosis of treatment-induced neuropathy of diabetes following confirmation by EMG.
DISCUSSION:
Gabapentin dose was increased, and duloxetine was initiated for neuropathic pain. The insulin regimen was optimized with increased glargine and prandial lispro to maintain glycemic control. The patient was referred for further rehabilitation and discharged to a skilled nursing facility (SNF) in stable condition.
This case highlights the complexity of managing treatment-induced neuropathy of diabetes, particularly when complicated by autonomic dysfunction. Rapid glycemic control was associated with significant peripheral neuropathy and orthostatic hypotension, consistent with TIND. Our case stresses the need for ongoing research due to the wide gap in the literature regarding TIND and reinforces for clinicians the importance of recognizing symptoms of TIND and its potential multisystem involvement.
Embargo Period
6-2-2025
Included in
Treatment-Induced Neuropathy of Diabetes Complicated by Orthostatic Hypotension: A Case Report
Philadelphia, PA
INTRODUCTION/BACKGROUND:
Treatment-induced neuropathy of diabetes (TIND) is a rare, iatrogenic small-fiber neuropathy caused by the rapid lowering of glucose levels in patients with previously poorly controlled diabetes. The prevalence of this condition remains undetermined as TIND remains an unrecognized complication of diabetes. In contrast to the classical sensory-motor polyneuropathy of diabetes, TIND is characterized by a more acute onset neuropathic pain. An important positive correlation exists between the magnitude and rate of change in HbA1c levels and the severity of symptoms. The more significant and rapid the decrease in HbA1c levels, the greater the intensity and distribution of neuropathic pain. This occurs independent of the agent used to correct the high HbA1c.
RESULTS:
A 50-year-old female with a significant history of poorly controlled type 2 diabetes mellitus (DM2) complicated by peripheral neuropathy presented to the ED following syncopal fall. During syncopal evaluation, the patient denied a prior history of stroke or seizures but reported long-standing orthostatic hypotension. A CT pan-scan revealed no acute processes. During the current admission, laboratory evaluations were unremarkable.
Per chart review, the patient previously presented with bilateral lower extremity weakness and paresthesias. A formal diagnosis of type II diabetes mellitus was made 5 months prior, when the patient’s HbA1c levels were reduced from 15.0 to 7.1. The patient was ultimately assigned a diagnosis of treatment-induced neuropathy of diabetes following confirmation by EMG.
DISCUSSION:
Gabapentin dose was increased, and duloxetine was initiated for neuropathic pain. The insulin regimen was optimized with increased glargine and prandial lispro to maintain glycemic control. The patient was referred for further rehabilitation and discharged to a skilled nursing facility (SNF) in stable condition.
This case highlights the complexity of managing treatment-induced neuropathy of diabetes, particularly when complicated by autonomic dysfunction. Rapid glycemic control was associated with significant peripheral neuropathy and orthostatic hypotension, consistent with TIND. Our case stresses the need for ongoing research due to the wide gap in the literature regarding TIND and reinforces for clinicians the importance of recognizing symptoms of TIND and its potential multisystem involvement.