Quiz Form

Question Date: 22/07/2023

Question: A 65 year old patient is newly diagnosed with Diabetes mellitus. His HbA1c is 12% and he is put on an intensive regimen to control sugars. After a month, he complains of severe neuropathic pain and postural hypotension. Nerve conduction study is normal. Which of these statements is true regarding his condition?

Options:

• The patient has distal sensory neuropathy due to diabetes mellitus
• Treatment induced neuropathy of Diabetes should be managed by allowing relaxation of tight blood sugar control
• Treatment with medication for neuropathic pain is effective
• Autonomic neuropathy is seen in treatment induced neuropathy of diabetes

Correct Answer: Autonomic neuropathy is seen in treatment induced neuropathy of diabetes

Explaination: Treatment induced neuropathy of diabetes mellitus (TIND), also called insulin neuritis, is an acute small fiber neuropathy seen with rapid correction of hyperglycemia. It is seen when Hba1c decreases by more than 2% over 3 months and can be seen with all oral hypoglycemics, insulin and weight loss. Severe neuropathic pain with allodynia and autonomic dysfunction is seen. Nerve conduction is normal and skin biopsy shows loss of intraepidermal nerve fiber density. Pain is refractory to treatment initially but improves gradually. Relaxation of blood sugar control is not recommended.

Reference: Gwathmey K. Sensory Polyneuropathies. Continuum 2017;23(5): 1411-1436.