Rapid Glucose Control May Bring on Acute Nerve Pain

Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy, by Christopher H. Gibbons and Roy Freeman. Annals of Neurology 67:534–541, 2010

What is the problem and what is known about it so far?

Nerve damage caused by diabetes is called diabetic neuropathy. About half of all people with diabetes have some form of nerve damage, which can cause chronic pain. However, a much smaller number of people with diabetes sometimes experience severe acute nerve pain. Sometimes this pain begins shortly after a person starts intensive diabetes therapy and gains rapid control of his or her blood glucose. This has been called “treatment-induced diabetic neuropathy” or “insulin neuritis.” Sometimes, nerve pain starts after a major weight loss. Occasionally, nerve pain can start from no apparent cause. Little is known about treatment-induced diabetic neuropathy and other forms of sudden nerve pain in people with diabetes.

Why did the researchers do this particular study?

Researchers wanted to learn more about patients with diabetes who experience treatment-induced diabetic neuropathy.

Who was studied?

The study included 16 people who sought treatment for acute nerve pain within 8 weeks of starting intensive glucose control.

How was the study done?

Researchers performed nerve and eye exams, laboratory tests, tests of the autonomic nervous system (which controls body functions such as heart rate, digestion, sweating, and sexual function), and pain assessments on patients over an 18-month period. Eight patients also had tests to measure the density of the nerves in their skin.

What did the researchers find?

Many patients had symptoms of autonomic nerve system problems involving the heart, digestive system, urinary system, and sweat glands. Nearly 70 percent also had problems with low blood pressure upon standing and poor functioning of the part of the nervous system that controls bodily functions such as digesting food and using the bathroom. All of the subjects also experienced a worsening of their existing eye problems (diabetic retinopathy). All of the patients whose skin nerves were tested had lower than normal nerve density. After 18 months of blood glucose control, the pain and all of the related conditions substantially improved. Greater improvements were seen in patients with type 1 diabetes than in those with type 2 diabetes.

What are the implications of the study

Rapid improvement in blood glucose can bring on sudden nerve pain in some people with diabetes who have previously had poor glucose control. However, maintaining good glucose control for the long-term can improve both the pain and its related nervous system problems.

  • Last Reviewed: September 13, 2013
  • Last Edited: October 7, 2013