Broadhead DY, Devenport SB. Sensorimotor Polyneuropathy in a Diabetic Patient After Rapid Overcorrection of Chronic Hyperglycemia.
J Investig Med High Impact Case Rep 2021;
9:23247096211051927. [PMID:
34654335 PMCID:
PMC8524692 DOI:
10.1177/23247096211051927]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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.
Collapse