Insulin Neuritis, recently renamed Treatment-Induced Neuropathy of Diabetes, (TIND) is a length dependent neuropathy characterized by pain and autonomic failure developing in association with treatment resulting in the rapid reduction of blood sugar levels. It is likely the least known kindred within the family of diabetic neuropathies which include increased susceptibility to focal mononeuropathies, mononeuropathy multiplex, radiculoplexus neuropathy, and sensori-motor axonal neuropathy.
Recently, Gibbons and Freeman have published a report (Brain 2015;138(1):2-3) studying a large group of subjects providing a much clearer picture of the incidence and risks of developing this disorder.
The primary take-home messages from this report are:
- TIND is relatively common, occurring in up to 10% of patients who had a decrease in Hb1AC greater than 2% shortly after initiating treatment.
- Patients with severe chronic hyperglycemia experience the highest risk for TIND secondary to measures that aggressively lower Hb1AC.
- Damage associated with TIND was also found to worsen the retinopathy and nephropathy of diabetic patients.
- Based on their study, the authors suggested that treatment goals should seek to reduce Hb1AC by less than 2% over a 3 month period.
For further reading please see this recent review that was posted on Medscape Insulin Neuritis-Treatment Induced Neuropathy of Diabetes. This review also discusses how chronic hyperglycemia leads to changes in the endoneurial microenvironment leading to reduced blood flow, a relative state of hypoxia, and increased reliance on anaerobic metabolism to sustain neural energy requirements.
With the incidence of diabetes and insulin sensitivity on the rise, the importance of early detection along with the appropriate dietary and/or nutrient intervention is essential to prevent our patients from reaching the point of chronic hyperglycemia.