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. 2005 Feb;81(952):103–107. doi: 10.1136/pgmj.2004.021162

Under-recognised paradox of neuropathy from rapid glycaemic control

M Leow 1, J Wyckoff 1
PMCID: PMC1743196  PMID: 15701742

Abstract

Insulin induced neuropathy has been reported previously in people with diabetes treated with insulin, and subsequently reported in patients with insulinomas. However, neuropathy caused by rapid glycaemic control in patients with poorly controlled diabetes with chronic hyperglycaemia is not a widely recognised entity among clinicians worldwide. It is expected that this phenomenon of paradoxical complication of neuropathy in the face of drastic decreases in glycosylated haemoglobin concentrations will assume greater importance with clinicians achieving glycaemic targets at a faster pace than before.

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Selected References

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  1. BASTRON J. A., LAMBERT E. H., MULDER D. W. Hyperinsulin neuropathy. Neurology. 1956 Sep;6(9):627–635. doi: 10.1212/wnl.6.9.627. [DOI] [PubMed] [Google Scholar]
  2. Bradshaw C., Steen I. N., Eccles M. Glycated haemoglobin levels in patients with diabetes in one general practice over a 10-year period. Diabet Med. 1995 Jul;12(7):628–631. doi: 10.1111/j.1464-5491.1995.tb00554.x. [DOI] [PubMed] [Google Scholar]
  3. Brusselmans K., Bono F., Maxwell P., Dor Y., Dewerchin M., Collen D., Herbert J. M., Carmeliet P. Hypoxia-inducible factor-2alpha (HIF-2alpha) is involved in the apoptotic response to hypoglycemia but not to hypoxia. J Biol Chem. 2001 Aug 23;276(42):39192–39196. doi: 10.1074/jbc.C100428200. [DOI] [PubMed] [Google Scholar]
  4. Carmeliet P., Dor Y., Herbert J. M., Fukumura D., Brusselmans K., Dewerchin M., Neeman M., Bono F., Abramovitch R., Maxwell P. Role of HIF-1alpha in hypoxia-mediated apoptosis, cell proliferation and tumour angiogenesis. Nature. 1998 Jul 30;394(6692):485–490. doi: 10.1038/28867. [DOI] [PubMed] [Google Scholar]
  5. Chase H. P., Lockspeiser T., Peery B., Shepherd M., MacKenzie T., Anderson J., Garg S. K. The impact of the diabetes control and complications trial and humalog insulin on glycohemoglobin levels and severe hypoglycemia in type 1 diabetes. Diabetes Care. 2001 Mar;24(3):430–434. doi: 10.2337/diacare.24.3.430. [DOI] [PubMed] [Google Scholar]
  6. Danta G. Hypoglycemic peripheral neuropathy. Arch Neurol. 1969 Aug;21(2):121–132. doi: 10.1001/archneur.1969.00480140021002. [DOI] [PubMed] [Google Scholar]
  7. ELLENBERG M. Diabetic neuropathy precipitating after institution of diabetic control. Am J Med Sci. 1958 Oct;236(4):466–471. [PubMed] [Google Scholar]
  8. Greenamyre J. T. The role of glutamate in neurotransmission and in neurologic disease. Arch Neurol. 1986 Oct;43(10):1058–1063. doi: 10.1001/archneur.1986.00520100062016. [DOI] [PubMed] [Google Scholar]
  9. Halterman M. W., Miller C. C., Federoff H. J. Hypoxia-inducible factor-1alpha mediates hypoxia-induced delayed neuronal death that involves p53. J Neurosci. 1999 Aug 15;19(16):6818–6824. doi: 10.1523/JNEUROSCI.19-16-06818.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Harmel Anne Peters, Ryan Diana, Thompson Robert. Glycohemoglobin assessment program: glycated hemoglobin and epidemiologic variables in patients with type 2 diabetes. Endocr Pract. 2002 May-Jun;8(3):184–190. [PubMed] [Google Scholar]
  11. Harrison M. J. Muscle wasting after prolonged hypoglycaemic coma: case report with electrophysiological data. J Neurol Neurosurg Psychiatry. 1976 May;39(5):465–470. doi: 10.1136/jnnp.39.5.465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Heckmann J. G., Dietrich W., Hohenberger W., Klein P., Hanke B., Neundörfer B. Hypoglycemic sensorimotor polyneuropathy associated with insulinoma. Muscle Nerve. 2000 Dec;23(12):1891–1894. doi: 10.1002/1097-4598(200012)23:12<1891::aid-mus17>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  13. Kihara M., Zollman P. J., Smithson I. L., Lagerlund T. D., Low P. A. Hypoxic effect of exogenous insulin on normal and diabetic peripheral nerve. Am J Physiol. 1994 Jun;266(6 Pt 1):E980–E985. doi: 10.1152/ajpendo.1994.266.6.E980. [DOI] [PubMed] [Google Scholar]
  14. Llewelyn J. G., Thomas P. K., Fonseca V., King R. H., Dandona P. Acute painful diabetic neuropathy precipitated by strict glycaemic control. Acta Neuropathol. 1986;72(2):157–163. doi: 10.1007/BF00685978. [DOI] [PubMed] [Google Scholar]
  15. Mandelbaum J. A., Felten D. L., Westfall S. G., Newlin G. E., Peterson R. G. Neuropathic changes associated with insulin treatment of diabetic rats: electron microscopic and morphometric analysis. Brain Res Bull. 1983 Mar;10(3):377–384. doi: 10.1016/0361-9230(83)90107-7. [DOI] [PubMed] [Google Scholar]
  16. Mohseni S. Hypoglycemic neuropathy. Acta Neuropathol. 2001 Nov;102(5):413–421. doi: 10.1007/s004010100459. [DOI] [PubMed] [Google Scholar]
  17. Nath R., Probert A., Jr, McGinnis K. M., Wang K. K. Evidence for activation of caspase-3-like protease in excitotoxin- and hypoxia/hypoglycemia-injured neurons. J Neurochem. 1998 Jul;71(1):186–195. doi: 10.1046/j.1471-4159.1998.71010186.x. [DOI] [PubMed] [Google Scholar]
  18. Ouyang Y. B., He Q. P., Li P. A., Janelidze S., Wang G. X., Siesjö B. K. Is neuronal injury caused by hypoglycemic coma of the necrotic or apoptotic type? Neurochem Res. 2000 May;25(5):661–667. doi: 10.1023/a:1007563104170. [DOI] [PubMed] [Google Scholar]
  19. Potter C. G., Sharma A. K., Farber M. O., Peterson R. G. Hypoglycemic neuropathy in experimental diabetes. J Neurol Sci. 1988 Dec;88(1-3):293–301. doi: 10.1016/0022-510x(88)90226-2. [DOI] [PubMed] [Google Scholar]
  20. Puri V., Garg N., Kumar N., Tatke M. Hypoglycaemic neuropathy: a case report. Neurol India. 2000 Sep;48(3):263–265. [PubMed] [Google Scholar]
  21. Savage S., Estacio R. O., Jeffers B., Schrier R. W. Increased complications in noninsulin-dependent diabetic patients treated with insulin versus oral hypoglycemic agents: a population study. Proc Assoc Am Physicians. 1997 Mar;109(2):181–189. [PubMed] [Google Scholar]
  22. Sidenius P., Jakobsen J. Anterograde fast component of axonal transport during insulin-induced hypoglycemia in nondiabetic and diabetic rats. Diabetes. 1987 Jul;36(7):853–858. doi: 10.2337/diab.36.7.853. [DOI] [PubMed] [Google Scholar]
  23. Sima A. A., Zhang W. X., Greene D. A. Diabetic and hypoglycemic neuropathy--a comparison in the BB rat. Diabetes Res Clin Pract. 1989 May 15;6(4):279–296. doi: 10.1016/0168-8227(89)90068-5. [DOI] [PubMed] [Google Scholar]
  24. Simmons Zachary, Feldman Eva L. Update on diabetic neuropathy. Curr Opin Neurol. 2002 Oct;15(5):595–603. doi: 10.1097/00019052-200210000-00010. [DOI] [PubMed] [Google Scholar]
  25. Sugimoto Kazuhiro, Baba Masayuki, Suda Toshihiro, Yasujima Minoru, Yagihashi Soroku. Peripheral neuropathy and microangiopathy in rats with insulinoma: association with chronic hyperinsulinemia. Diabetes Metab Res Rev. 2003 Sep-Oct;19(5):392–400. doi: 10.1002/dmrr.395. [DOI] [PubMed] [Google Scholar]
  26. Wieloch T. Hypoglycemia-induced neuronal damage prevented by an N-methyl-D-aspartate antagonist. Science. 1985 Nov 8;230(4726):681–683. doi: 10.1126/science.2996146. [DOI] [PubMed] [Google Scholar]
  27. Wilson Jennifer L., Sokol Deborah K., Smith Lisa H., Snook Riley J., Waguespack Steven G., Kincaid John C. Acute painful neuropathy (insulin neuritis) in a boy following rapid glycemic control for type 1 diabetes mellitus. J Child Neurol. 2003 May;18(5):365–367. doi: 10.1177/08830738030180051701. [DOI] [PubMed] [Google Scholar]
  28. Yasaki S., Dyck P. J. Spatial distribution of fiber degeneration in acute hypoglycemic neuropathy in rat. J Neuropathol Exp Neurol. 1991 Nov;50(6):681–692. doi: 10.1097/00005072-199111000-00001. [DOI] [PubMed] [Google Scholar]

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