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

• 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
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-241849

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.