Diagnosis and Treatment of a Typical Painful Neuropathy Due to "Insulin Neuritis" in Patients with Diabetes

Abstract

Diabetes is very common and its global prevalence is rising day by day. As a result we are seeing more complications related to diabetes. In order to prevent micro vascular and macro vascular complications such as retinopathy, nephropathy, erectile dysfunction, neuropathy, myocardial infarction and stroke health care professionals are keen to have better glycaemic control. When dealing with newly diagnosed or poorly controlled diabetes patients are encouraged to bring down glycated haemoglobin (HbA1c). Diabetic painful neuropathy (DPN) is one of the well-known complications associated with long- term poor glycaemic control. However, on the other hand rapid control of high blood sugar can precipitate painful neuropathy known as “insulin neuritis”. The rapid tight glycaemic control with either insulin or oral hypoglycaemic agents on poorly controlled diabetic patients cause flux of blood glucose and metabolic shift resulting in structural changes at nerve endings (endoneural blood vessels) which resemble the retinopathy changes in retina. It causes steal effect and hypoxia in the nerves and hence precipitates neuropathic pain. It lasts for about 6 months and responds well to standard treatment of painful neuropathy. Health professionals need to be aware of this condition and consider gentle glycaemic control when aiming for Target HbA1c. This review outlines the disease, the symptoms, the types and treatment.