Sensorimotor Polyneuropathy in a Diabetic Patient After Rapid Overcorrection of Chronic Hyperglycemia

Abstract

The differential diagnosis for peripheral neuropathy of uncertain etiology is extensive, and the work-up presents a diagnostic challenge for the physician. Following initial clinical assessment, we recommend electrodiagnostic studies as the test of choice in the evaluation of peripheral neuropathy of unclear cause. Subsequent laboratory testing can then be better specified according to the results of the electrodiagnostic studies and clinical assessment. This case report presents a 66-year-old female with a history of uncontrolled type-II diabetes who developed prominent sensorimotor neuropathy after experiencing several hypoglycemic episodes. Due to difficulties with insulin titration, over the course of 4 weeks, the patient quickly and drastically lowered her chronically elevated average serum glucose concentration to the point of suffering multiple periods of hypoglycemia. Soon after, she developed paresthesia in her hands and feet, as well as significant weakness in both upper and lower extremities. Unfortunately, the patient was lost to follow-up before a definitive diagnosis could be established. Hypoglycemia and rapid correction of long-standing hyperglycemia are relatively under-recognized sources of neuropathy in diabetic patients. Physicians taking care of diabetic patients who develop peripheral neuropathy following rapidly improved glycemic control or hypoglycemia should be aware of the possibility of a diabetic neuropathy and begin prompt work-up to exclude other causes before making the diagnosis of treatment-induced diabetic neuropathy or hypoglycemic neuropathy.

Treatment‐induced neuropathy of diabetes: an update

“…13 Its prevalence in subjects with diabetes in a third-level reference centre was reported to be 10.9%. 13 Cases reported in the literature 4,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] show that the mean age of those affected by TIND is 36.55 years (95% , and that there is a slight male predominance (57.14% vs 42.86%). Type 1 DM was more frequent than type 2 DM (64.29% vs 35.71%), and patients had the disease for a mean of 4.9 years (95% CI 3.17-6.64).…”

“…Case reports of treatment-induced neuropathy of diabetes. 4,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (Continued on from the previous 2 pages)…”

“…Cases reported in the literature 4,14–31 show that the mean age of those affected by TIND is 36.55 years (95% CI 30.99–42.11), and that there is a slight male predominance (57.14% vs 42.86%). Type 1 DM was more frequent than type 2 DM (64.29% vs 35.71%), and patients had the disease for a mean of 4.9 years (95% CI 3.17–6.64).…”

“…Treatment of TIND includes the use of the same drugs prescribed for painful diabetic neuropathy and the maintenance of adequate glycaemic control Case reports of treatment-induced neuropathy of diabetes 4,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. (Continued on the next 2 pages)…”

“…4,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (Continued on the next page)…”