Acute Painful Neuropathy Restricted to the Abdomen following Rapid Glycaemic Control in Type 2 Diabetes

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

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.

Concomitance of diabetic neuropathic amyotrophy and cachexia: a case report with review of the literature

Diabetic amyotrophy is a rare condition in which patients develop severe aching or burning pain in hips and thighs. This is followed by weakness and wasting of the muscles of proximal lower extremities, which often occur asymmetrically. Diabetic neuropathic cachexia is a different type of diabetic neuropathies. It leads to intense pain in affected extremities accompained by anorexia, weight loss as well as mood and sleep disturbances. A 42-year-old type 2 diabetic woman with a known poor glycemic control presented with loss of appetite, and weight (approximately 15 kg), severe burning sensation over her lower limbs, depression and sleep disturbances for 3 months. Symmetric wasting was noted in her proximal lower extremities with bilateral muscle weakness. Her patella and Achilles reflexes were absent with decrease in her upper extremity reflexes. We evaluated the patient as diabetic amyotrophy associated with diabetic neuropathic cachexia based on clinical signs, electrophysiological and radiological examination findings. Physicians should take into consideration these rare complications of diabetes mellitus showing characteristics different from other types of neuropathies.

Acute painful neuropathy induced by rapid correction of serum glucose levels in diabetic patients

We report on acute painful neuropathy following reduction of high serum glucose levels in six diabetic patients, aged 27-52 (5 males). Initial glucose levels ranging between 270 and 600 mg/dL decreased to 60-160 mg/dL following insulin, pharmacologic or dietary treatment. Four patients had long-standing untreated diabetes (3-5 years). All six patients experienced severe excruciating neuropathic pain 2-4 weeks after initiation of treatment. Pain was generalized in all, starting in the feet in 4 cases. Pain intensity prompted the use of combination therapy with various anti-neuropathic pain agents. Symptoms gradually improved in all patients, allowing discontinuation of symptomatic therapy within 3-8 months. We conclude that acute painful neuropathy can complicate the correction of high glucose levels in diabetic patients. Therefore, careful correction of glucose levels should be considered in patients with long-standing uncontrolled diabetes.