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

Abstract

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.

Insuline use could increase the risk of obstructive sleep apnea in type 2 diabetes mellitus

“…The association between insulin and worsening of diabetic neuropathy may also be a hypothesis to explain the higher risk association for OSA in T2DM patients using insulin. It has been shown that rapid changes in glycohemoglobin can lead to the progression of diabetic neuropathy 15 . Diabetic neuropathy could lead to autonomic dysfunction, reducing the central control of breathing and worsening the intrinsic muscle function of the larynx, leading to a greater tendency of these muscles to collapse, which would lead to a worsening of OSA.…”

Excitatory and inhibitory neuronal signaling in inflammatory and diabetic neuropathic pain

“…The development of severe, burning pain upon initiation of insulin therapy against diabetes was first reported in 1933 (Caravati 1933 ). Initially termed diabetic neuritis, such symptoms are often described by patients after introducing tight glycemic control (Stainforth-Dubois and McDonald 2021 ), or observed in conjunction with long-term reduced blood glucose levels due to poorly adjusted insulin treatment (Ferreira et al 2021 ). Some 10% of diabetic patients report this complication which is now termed treatment induced neuropathy in diabetes (TIND) (Ferreira et al 2021 ; Gibbons 2020 ; Stainforth-Dubois and McDonald 2021 ).…”

Treatment‐induced neuropathy of diabetes: an update

“…33 Table 1 shows the drugs used in TIND. 6,20,24,32,[48][49][50]52 Use cautiously in kidney disease and adjust for renal function as needed.…”

“…[3][4][5] One of them is the treatment-induced neuropathy of diabetes (TIND), which is an acute and painful small-fibre neuropathy associated with rapid glycaemic control, and mainly observed in patients with poor previous glycaemic control. 6 This condition was first described in 1933, in a female with diabetes who developed severe burning pain after starting insulin therapy. The condition remitted after suspending insulin, and it reappeared after restarting insulin.…”

“…The most common form is distal symmetric polyneuropathy, which accounts for almost 75% of all cases; however, there are some less frequent forms 3–5 . One of them is the treatment‐induced neuropathy of diabetes (TIND), which is an acute and painful small‐fibre neuropathy associated with rapid glycaemic control, and mainly observed in patients with poor previous glycaemic control 6 . This condition was first described in 1933, in a female with diabetes who developed severe burning pain after starting insulin therapy.…”