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Treatment-induced neuropathy of diabetes: challenges in diagnosing neuropathic pain, value of sudomotor function testing
  1. Salim Abdelhamid1,
  2. Majlinda Shabani1,
  3. Arkadiusz Russjan2 and
  4. Alexander Andrea Tarnutzer3
  1. 1Internal Medicine, Kantonsspital Baden AG, Baden, Switzerland
  2. 2Department of Neurology and Neurorehabilitation, Zurzach Care AG, Bad Zurzach, Switzerland
  3. 3Neurology, Kantonsspital Baden AG, Baden, Switzerland
  1. Correspondence to Dr Alexander Andrea Tarnutzer; alexander.tarnutzer{at}


A patient in his 60s was admitted for an extensive neurological work-up due to progressive asymmetrical, distally pronounced pain in both feet and legs. Conventional pain relievers did not help in pain reduction. A Sudoscan revealed small fibre damage in all extremities indicating an underlying neuropathy. The patient had started insulin treatment around 6 months prior to hospitalisation because of a newly diagnosed late-onset diabetes. Due to a rapid drop in glycated haemoglobin (from over 14% to 6% in 4 months), treatment-induced neuropathy of diabetes (TIND) was hypothesised. On increasing the dose of pregabalin and adding duloxetine, the patient reported improvement of symptoms, which further underlined the suspected diagnosis. Hence, in patients with severe hyperglycaemia, changes in glycaemic control should be stepwise and not rapid; however, to date, no guidelines exist how to avoid TIND.

  • Neuromuscular disease
  • Peripheral nerve disease
  • Diabetes

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SA and AAT. The following authors gave final approval of the manuscript: AAT, AR, MS and SA.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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