Neuropatia induzida pelo tratamento: uma complicação iatrogénica da diabetes

Abstract

Introduction: Treatment-induced neuropathy, so far called insulin neuritis, is an acute neuropathy that occurs in diabetic patients when they undergo strict glycemic control in a short period of time. Case description: 66-year-old woman diagnosed with type 2 diabetes mellitus since 1990 with nephropathy and retinopathy as complications, and poor glycemic control. She also presented with hypertension and dyslipidemia as active health problems, without other relevant clinical antecedents. In June 2016, isophane insulin was introduced in order to achieve better glycemic control. Two weeks later, the patient had another appointment due to intense hyperhydrosis, nausea, dizziness, and a feeling of fainting in both pre and postprandial periods, which was interpreted as hypoglycemia. A week later she presents to the consultation with complaints of paresthesias and dysesthesias of the lower limbs, and maintenance of the autonomic dysfunction symptoms. On physical examination, the findings were compatible with peripheral neuropathy and, after reviewing the clinical process, we found that glycated hemoglobin decreased 2.1% in three months. The patient was medicated with increasing doses of pregabalin for symptomatic relief and the reversible nature of the situation was explained. At follow-up in September, the patient was asymptomatic without need of adjuvant analgesics. Comment: This case allows us to revisit this clinical entity, which is often confused with diabetic neuropathy, and to alert to the iatrogenic potential of an intensive therapeutic regimen in a short period of time.