Acute diabetic neuropathy following improved glycaemic control: a case series and review.
Diabetes mellitus type 2
Error in diagnosis/pitfalls and caveats
Nerve conduction study
Oculomotor nerve palsy
Vision - blurred
MetadataShow full item record
JournalEndocrinology, diabetes & metabolism case reports
AbstractSummary: We present three cases of acute diabetic neuropathy and highlight a potentially underappreciated link between tightening of glycaemic control and acute neuropathies in patients with diabetes. Case 1: A 56-year-old male with poorly controlled type 2 diabetes (T2DM) was commenced on basal-bolus insulin. He presented 6 weeks later with a diffuse painful sensory neuropathy and postural hypotension. He was diagnosed with treatment-induced neuropathy (TIN, insulin neuritis) and obtained symptomatic relief from pregabalin. Case 2: A 67-year-old male with T2DM and chronic hyperglycaemia presented with left lower limb pain, weakness and weight loss shortly after achieving target glycaemia with oral anti-hyperglycaemics. Neurological examination and neuro-electrophysiological studies suggested diabetic lumbosacral radiculo-plexus neuropathy (DLPRN, diabetic amyotrophy). Pain and weakness resolved over time. Case 3: A 58-year-old male was admitted with blurred vision diplopia and complete ptosis of the right eye, with intact pupillary reflexes, shortly after intensification of glucose-lowering treatment with an SGLT2 inhibitor as adjunct to metformin. He was diagnosed with a pupil-sparing third nerve palsy secondary to diabetic mononeuritis which improved over time. While all three acute neuropathies have been previously well described, all are rare and require a high index of clinical suspicion as they are essentially a diagnosis of exclusion. Interestingly, all three of our cases are linked by the development of acute neuropathy following a significant improvement in glycaemic control. This phenomenon is well described in TIN, but not previously highlighted in other acute neuropathies. Learning points: A link between acute tightening of glycaemic control and acute neuropathies has not been well described in literature. Clinicians caring for patients with diabetes who develop otherwise unexplained neurologic symptoms following a tightening of glycaemic control should consider the possibility of an acute diabetic neuropathy. Early recognition of these neuropathies can obviate the need for detailed and expensive investigations and allow for early institution of appropriate pain-relieving medications.
- Rare case of diabetic neuropathic cachexia along with diabetic amyotrophy.
- Authors: Khan ZU, Ghuman N, Mak K
- Issue date: 2021 May 31
- Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis).
- Authors: Tesfaye S, Malik R, Harris N, Jakubowski JJ, Mody C, Rennie IG, Ward JD
- Issue date: 1996 Mar
- Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes.
- Authors: Gibbons CH, Freeman R
- Issue date: 2015 Jan
- Repaglinide : a pharmacoeconomic review of its use in type 2 diabetes mellitus.
- Authors: Plosker GL, Figgitt DP
- Issue date: 2004
- Insulin neuritis and diabetic cachectic neuropathy: a review.
- Authors: Knopp M, Srikantha M, Rajabally YA
- Issue date: 2013 May
Showing items related by title, author, creator and subject.
Atlantic DIP: Diabetes in Pregnancy: a comparative study of stress and wellbeing in women with established diabetes, gestational diabetes, and those without diabetesLydon, K; McGuire, B; Owens, LA; Sarma, K; Avalos, G; Carmody, L; O'Connor, C; Nestor, L; Dunne, F; Department of Medicine, National University of Ireland, Galway, Galway, Ireland, 2School of Psychology, National University of Ireland, Galway, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09-15)Background and aims: Diabetes in pregnancy increases the risk of maternal and perinatal morbidity and mortality. The experience of diabetes during pregnancy may be a significant source of stress, both because of the impact of the illness and associated treatments on the expectant mother and because of concern about the impact on the unborn child. In order to examine stress associated with diabetes during pregnancy, we carried out a prospective study in women with pre-existing (Type 1 or Type 2) Diabetes (PDM), Gestational Diabetes Mellitus (GDM), and non-diabetic pregnant controls (NDM). Materials and methods: The participants were 210 pregnant women - 25 with pre-existing diabetes (PDM), 77 with GDM and 108 healthy controls (NDM). All were attending antenatal services in six health care centres in Ireland. We measured stress and wellbeing with several standardised psychological questionnaires including The Pregnancy Experience Scale; The Depression Anxiety Stress Scale; the Multidimensional Perceived Social Support Scale; the Illness Perception Questionnaire-Diabetes; the Diabetes Self-Efficacy Scale; the SF-8 and the Problem Areas in Diabetes Scale. We hypothesized that diabetic women would report higher levels of stress than healthy controls and we also hypothesized that social support may confer a protective role. Results: We found a non-significant trend of increased stress and lower quality of life among diabetic women compared to non-diabetic controls. Women with PDM perceived their illness as having a higher impact on their lives than those with GDM (p<0.0001). However, women with pre-existing diabetes also reported significantly greater self-efficacy in relation to their diabetes management compared to their gestational diabetes counterparts (p<0.05). The results of the remaining questionnaires demonstrate a general trend towards higher distress in diabetic women compared to controls. The healthy controls reported higher perceived social support which may confer a protective role against psychological stress. Conclusion: These preliminary results suggest that pregnant diabetic women perceive themselves as having a lower quality of life and higher levels of stress in pregnancy, especially women with pre-existing diabetes. This may indicate a need for psychological support in these patients. However, further research is required.
ATLANTIC DIP: The prevalence of pre-diabetes/type 2 diabetes in an Irish population with gestational diabetes mellitus 1-5 years post index pregnancyCrowe, C; Noctor, E; Carmody, LA; Wickham, B; Avalos, G; Gaffney, G; O’Shea, P; Dunne, F (2012-08-15)
An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trialInfanti, Jennifer J; Dunne, Fidelma P; O’Dea, Angela; Gillespie, Paddy; Gibson, Irene; Glynn, Liam G; Noctor, Eoin; Newell, John; McGuire, Brian E (2013-05-02)Abstract Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. Methods/Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n = 27) or to the Croí MyAction intervention group (n = 27). The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction. Croí MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691). Trial registration Current Controlled Trials ISRCTN41202110.