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Treatment-induced diabetes neuropathy: reminder of an important clinical lesson
  1. Mafalda Ferreira,
  2. Guilherme Camoes,
  3. João Filipe de Ferreira Gomes and
  4. Diana M Ferreira
  1. Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
  1. Correspondence to Dr Mafalda Ferreira; mafalda.alvesferreira{at}


Treatment-induced neuropathy of diabetes (TIND) is an acute, painful and rare complication of intensive glycaemic control in diabetes. We present a case of a 32-year-old man with sudden onset of severe lower limb pain. It worsened progressively and was refractory to analgesic and muscle relaxant therapies. It became so severe that the patient was impossible to stand, causing a marked impact on his daily life. He had a history of type 1 diabetes, diagnosed 3 years ago, and an episode of deep vein thrombosis of the left leg, 4 years ago. While completing an extensive workup, various analgesic adjustments were made, with no improvement. After careful revision of his medical data, a significant reduction of his A1C 6 months before the appearance of symptoms was noticed. A diagnosis of TIND was made. The patient was treated with amitriptyline and showed noticeable improvement after the first month.

  • endocrine system
  • diabetes
  • peripheral nerve disease

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  • Contributors MF was responsible for the conception and design of the article with the support of GC and JG. DF was responsible for the final review and approval of the submitted manuscript. All authors worked on the case, read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.