IMPROVED METABOLIC CONTROL-A CAUSE OF DIABETIC NEUROPATHY

Abstract

Two adolescents, both 17 years, began intensified therapy to improve glycemic control (HbA1c 17.0%, 9.0%). Physical examinations were normal. Baseline neurophysiologic studies (Biothesiometry and NCV) demonstrated mild sensory nerve dysfunction, not due to heavy metal toxicity or vitamin deficiency. Intensified conventional diabetes therapy improved their diabetes control. Hb A1c values were <8.5% at 8 weeks after beginning therapy. Four to six weeks after beginning therapy, each patient developed distal, symmetrical polyneuropathy characterized by pain and/or numbness of extremities. Despite improved metabolic control, repeat neurophysiologic studies were unchanged. A 15-year-old female presented with right facial paresis and pedal dysesthesias. Her glycemic control was similarly improved(Table). Six weeks later she reported severe leg pain and worsening of existing symptoms without neurophysiologic change. In all three patients, symptoms completely subsided in 3 to 4 months without improvement in neurophysiologic tests. Improved metabolic control may exacerbate silent or overt neuropathy in young diabetics. Resolution of symptoms in response to treatment protocols may not indicate improved nerve function.