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When the Treatment Becomes the Problem.

Vivek-Thomas J Sankoorikal, Janet Ricks

Journal of the Mississippi State Medical Association

|May 10, 2017

Summary

A patient with type 2 diabetes experienced worsening symptoms including weight loss and joint pain after starting insulin therapy. This case highlights potential adverse effects of insulin treatment in diabetic patients.

Area of Science:

Endocrinology
Pharmacology

Background:

Type 2 diabetes mellitus (T2DM) management often involves lifestyle changes and oral medications.
Insulin therapy is a common progression for patients with inadequately controlled T2DM.

Observation:

A 47-year-old male with T2DM presented with uncontrolled hyperglycemia, unintentional weight loss, and fatigue.
Symptoms of myalgias, arthralgias, and peripheral neuropathy (numbness and tingling in feet) emerged after initiating insulin glargine/aspart and later insulin detemir.

Findings:

Despite treatment with sitagliptin/metformin, hyperglycemia persisted.
The patient developed significant adverse symptoms, including migratory joint pain, muscle aches, and foot paresthesia, temporally associated with insulin initiation and titration.

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Implications:

This case underscores the importance of considering iatrogenic causes for new-onset symptoms in patients with diabetes.
Further investigation is warranted to determine the specific mechanism linking insulin therapy to the observed myalgias and arthralgias in this patient.