Disclosures: Andrew J. Maza: Forest Devices, Inc. (Products/Services: No) (Consultant/Advisory Board, Employment, Stockholder/Ownership Interest (excluding diversified mutual funds))

Case Diagnosis: A 48-year-old man developed treatment-induced neuropathy of diabetes.

Case Description or Program Description: The patient presented to family medicine with uncontrolled type 2 diabetes mellitus. His hemoglobin A1C (HbA1C) measured 9.5%, and he was prescribed 25 units of insulin detemir U-100 to be injected nightly and 5 units of insulin lispro U-100 to be injected three times daily with meals. The patient presented to Physical Medicine and Rehabilitation (PM&R) 1 month later with complaints of numbness, weakness, and decreased strength in the left lateral calf and foot. The physical exam showed left-sided piriformis syndrome, but FABER, Thomas, and straight leg raise tests were unremarkable. An MRI of the lumbar spine showed no signs of radiculopathy. Three weeks later, the patient underwent electromyography which resulted in increased insertional activity at the left anterior tibialis, left peroneus longus, and left gastrocnemius muscles. Fibrillations were also noted: 1+ at the left anterior tibialis, 2+ at the left peroneus longus, and 2+ at the left gluteus medius muscles.

Setting: Acute care hospital.

Assessment/Results: The patient showed no signs of lower extremity weakness nor gait abnormalities after 2 weeks of chiropractic treatment. HbA1C measured 4.8% nearly 3 months later. Glycemic control with insulin continued.

Discussion (relevance): Treatment-induced neuropathy of diabetes is a rare, perhaps underreported, diagnosis. Reducing HbA1C by more than 2 percentage points over 3 months may increase its risk. As a testament to this risk, this patient developed neuropathy after his HbA1C was reduced by greater than 4% in a 3-month period.

Conclusions: Providers should be aware of the risk of treatment-induced neuropathy of diabetes, also previously known as insulin neuritis. It is an iatrogenic neuropathy that can occur after rapid and aggressive improvement in glycemic control, even when such diabetic treatment proves effective.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/iatrogenic-insulin-induced-neuropathy-in-a-poorly-controlled-type-2-diabetic-patient-a-case-report/