E-Pearls of the Week: Treatment-induced neuropathy

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July 15, 2013

Treatment-induced Neuropathy

Treatment-induced neuropathy is an acute, painful polyneuropathy associated with rapid correction of hyperglycemia in diabetics. It presents with severe, refractory neuropathic pain which may be length dependent or diffuse. Allodynia, hyperalgesia and autonomic dysfunction are also common. There is reversible damage to unmyelinated and lightly myelinated nerve fibers with unclear pathogenesis. Initially described by Cavarati in 1933 as "insulin neuritis," the term "treatment-induced neuropathy" is preferred as there is no inflammatory process.  Prognosis is good and pain resolves over several months without specific treatment. Poor diabetic control may lead to relapse.


1. Smith AG, Singleton JR. Diabetic neuropathy. Continuum 2012; 18: 60-84.

2. Cavarati CM. Insulin neuritis: a case report.  Va Med Monthly 1933; 59: 745-746.

3. Gibbons CH, Freeman R. Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy.  Ann Neurol. 2010; 67: 534-541.

Submitted by Ajay Sood MD, PhD and Sameer Sharma MBBS Upstate Medical University Syracuse, New York

Drs.  Sood and Sharma report no disclosures.

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