Thread by @iamnephrologist

⁉️How frequently do you diagnose "Treatment Induced Neuropathy" or Insulin Neuritis in your diabetic patient presenting with painful neuropathy ?

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🌸Treatment Induced Neuropathy of Diabetes (TIND)

💡Iatrogenic complication of aggressive glycemic control

🔥Underdiagnosed
💡>10% cases with diabetic neuropathy symptoms have actually TIND‼️

Ref- Brain;Autonomic Neuroscience
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🌸Treatment Induced Neuropathy of Diabetes

♨️aka Insulin Neuritis
🔥1st report: Caravati (1933)
🔥Actual incidence>Expected incidence
🔆Painful small fiber/Autonomic neuropathy
🔆T1DM>T2DM
🔆Insulin>OHA

Ref-BRAIN2015:138;43-52
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🌸Treatment Induced Neuropathy of Diabetes

♨️Trigger: Rapid improvement in glycaemic control in long uncontrolled DM

♨️Burning/shooting pain(length dependent pattern)
 ±Allodynia/Hyperalgesia
f/b Autonomic symptom

Ref-BRAIN2015:138;43-52
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🌸Treatment Induced Neuropathy of Diabetes

♨️TIND severity ∝ Rate of HbA1c change
♨️Other risks: Duration of Diabetes & other comorbid conditions

Ref-BRAIN2015:138;43-52
Doi:10.1016/j.autneu.2020.102668
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🌸Treatment Induced Neuropathy of Diabetes

♨️TIND vs DSPN
👉Acute onset (< 8wk of glycaemic change)
👉More severe, extensive, poorly responsive pain
👉Allodynia/Hyperalgesia
👉Autonomic symptom

Doi:10.1016/j.autneu.2020.102668
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter

🌸Treatment Induced Neuropathy of Diabetes

♨️Proposed mechanisms (Unproven):
👉Endoneurial ischaemia
👉AV shunts
👉Apoptosis
👉Microvascular neuronal damage
👉Ectopic firing of regenerating axon sprouts

Ref:BRAIN2015:138;43–52
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🌸Treatment Induced Neuropathy of Diabetes

♨️Appropriate management unknown
🔥"Permissive Hyperglycemia" helps‼️(as in early DR)
🔥Pain initially unresponsive but improve with time (over 12-24 months)

Ref-BRAIN2015:138;43-52
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter