Peripheral and Autonomic Neuropathy in an Adolescent with Type 1 Diabetes Mellitus: Evidence of Symptom Reversibility after Successful Correction of Hyperglycemia

Abstract

Introduction: Diabetic neuropathy is the most frequent chronic complication of Diabetes Mellitus (DM), currently considered an irreversible end-organ damage complication. The present case concerns a teenage patient, who after effective glycemic control, was shown to regain sensitive and autonomic nerve function. Case Report: An 18-year-old female patient with Type 1 DM with 6 years of evolution since diagnosis and poor metabolic control (HbA1c 13%) presents to our outpatient clinic with severe sock-pattern burning pain sensation in both lower limbs, which is perceived to have worsened in the previous 6 months despite receiving gabapentin and pregabalin, prescribed in another health center. At physical examination, orthostatic hypotension was evidenced after a fast transition to standing position, tachycardia, muscular hypotrophy of both quadriceps and sural triceps, with a negative Rydel-Seiffert test and a positive Romberg test. Patellar and calcaneal osteotendinous hyporreflexia were found, while hyperalgesia and allodynia to palpation of both feet were present. The RINES-VALCARDI test yielded 8 points at first consultation. She was given patient education concerning her disease and started a strict diet as well as an appropriate insulin therapy to achieve metabolic control. She was treated with duloxetine and capsaicin cream, treatments which she abandoned 6 months later with no observable or measurable relapse of her nerve dysfunctional symptoms; not even one year afterwards. Discussion: This case is unique due to several aspects: The severity of hyperalgesia, and the reversibility of both peripheral and autonomic symptoms after glycemic control and patient education. These elements are fundamental pertaining to reversion of nerve damage.

Glycemic Variability and Diabetic Neuropathy in Young Adults With Type 1 Diabetes

“…DSPN and CAN are usually rare problems during childhood but may be present in adolescents and young adults (3,4). Improved glycemic control in patients with type 1 diabetes may prevent and revert early stages of DSPN and CAN and slow the progression toward overt neuropathy (5)(6)(7)(8)(9). Thus, detecting and preventing diabetic neuropathy at an early stage is essential.…”