[Treatment-induced neuropathy of diabetes in a 44-year-old woman]

There is strong evidence that improved blood glucose control in individuals with diabetes mellitus reduces the risk of complications and leads to better long-term health outcomes. However, a rapid reduction in blood glucose levels can also lead to microvascular complications. Treatment-induced neuropathy in diabetes (TIND) is a painful neuropathy that may occur following a rapid decrease in blood glucose in patients with previously poorly controlled diabetes. This case report describes a woman who developed burning pain and sleep disturbances after being diagnosed with type 1 diabetes and undergoing a rapid reduction in blood glucose levels. Further investigations revealed diabetes-induced small fiber neuropathy consistent with TIND. Some studies suggest limiting the rate of blood glucose to reduce the risk of TIND, although current evidence is insufficient to support general recommendations. In patients with established TIND, increasing glucose levels is not advised. Management is instead symptomatic, focusing on relief of neuropathic pain and addressing any autonomic involvement. The prognosis is generally favourable.