Endocrine Abstracts

Introduction: Treatment-induced neuropathy of diabetes (TIND) is a small fibre neuropathy precipitated by rapid correction of chronic hyperglycemia.

Methods: We report two patients who developed TIND after rapid improvement of glycaemic control.

Results: 21-year-old gentleman, underlying type 2 DM diagnosed since 2017. He was not compliant to insulin therapy and defaulted follow up. His Hba1c ranged from 16.6%-19%. In July 2020, he was admitted for diabetic ketoacidosis and dengue fever. He was discharged with basal bolus insulin. Within a month after discharge, he experienced severe lower limb pain. The pain worsened at night and affected his sleep. On examination, he had increased pinprick sensation over bilateral lower limb dermatomes. Hba1c was reduced markedly to 8.9%. His urine biochemistry revealed proteinuria. He was started on Gabapentin and Vitamin B1, B6 and B12. His insulin dose was reduced. A month later, his neuropathic symptoms had much improved. His subsequent neurological examination revealed reduced pinprick sensation at gloves and stocking distribution. Nerve conduction study (NCS) revealed symmetrical length dependent sensory motor predominantly axonal polyneuropathy, suggestive of diabetic neuropathy. 36-year-old lady, diagnosed with type 2 DM since 2016 and was started on Sitagliptin/Metformin. Nevertheless, she defaulted her follow up and medication. In September 2020, she was admitted for diabetic ketoacidosis with Hba1c > 14%. She was discharged with basal bolus insulin. During follow up, she complained of severe lower limb pain since discharge, with pin and needle sensation, worsened at night. Her neurological examinations were unremarkable. Hba1c had been reduced substantially to 8.7%. She was commenced on Gabapentin and Amitriptyline. One month later, her neuropathic symptoms improved markedly. NCS showed symmetrical length dependent sensory motor axonal polyneuropathy, suggestive of diabetic neuropathy.

Conclusion: These 2 cases highlight the importance of early detection and timely management of this distressing and potentially debilitating condition. The condition may be prevented by gradual titration of glycaemic control treatment, especially in long standing poorly controlled diabetic patients.