Treatment-induced diabetes neuropathy: reminder of an important clinical lesson

Treatment-induced neuropathy of diabetes (TIND) is an acute, painful and rare complication of intensive glycaemic control in diabetes. We present a case of a 32-year-old man with sudden onset of severe lower limb pain. It worsened progressively and was refractory to analgesic and muscle relaxant the...

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Published in:BMJ case reports 2021-05, Vol.14 (5), p.e241849
Main Authors: Ferreira, Mafalda, Camoes, Guilherme, Gomes, João Filipe de Ferreira, Ferreira, Diana M
Format: Article
Language:English
Subjects:
Adult
Analgesics
Asymptomatic
Case Report
Case reports
Diabetes
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - drug therapy
Diabetic Neuropathies - drug therapy
Diabetic neuropathy
Drug dosages
Electromyography
Glucose
Humans
Hypotheses
Insulin
Male
Pain
Pathophysiology
Patients
Thrombosis
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Summary:Treatment-induced neuropathy of diabetes (TIND) is an acute, painful and rare complication of intensive glycaemic control in diabetes. We present a case of a 32-year-old man with sudden onset of severe lower limb pain. It worsened progressively and was refractory to analgesic and muscle relaxant therapies. It became so severe that the patient was impossible to stand, causing a marked impact on his daily life. He had a history of type 1 diabetes, diagnosed 3 years ago, and an episode of deep vein thrombosis of the left leg, 4 years ago. While completing an extensive workup, various analgesic adjustments were made, with no improvement. After careful revision of his medical data, a significant reduction of his A1C 6 months before the appearance of symptoms was noticed. A diagnosis of TIND was made. The patient was treated with amitriptyline and showed noticeable improvement after the first month.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-241849