Insulin neuritis in pregnancy

Abstract

Insulin neuritis is a rare, reversible, acute, painful neuropathy which may occur after rapid improvements in glycaemic control in people with diabetes. We describe a previously unreported association of insulin neuritis occurring in early pregnancy in two Caucasian women with type 1 diabetes. A 28 year old with diabetes for three years presented at seven weeks gestation with acute onset of severe pain and paraesthesia in both feet, worse at night. Pre-conception HbA1c was 132 mmol/mol and 53 mmol/mol at nine weeks gestation. The pain was managed with amitriptyline and tramadol. Her symptoms resolved by 20 weeks. Another 30 year old with diabetes of 23 years duration developed acute painful neuropathic symptoms in both feet at 12 weeks gestation. HbA1c was 147 mmol/mol prior to conception and 70 mmol/mol at 15 weeks gestation. She obtained some symptom relief from amitriptyline. She also required laser therapy for worsening retinopathy during this and a previous pregnancy. Insulin neuritis (also termed treatment induced neuropathy) occurs in people with both type 1 and type 2 diabetes with rapidly improving glucose control irrespective of treatment regimen. It was first described and most commonly occurs on initiation of insulin, but here was associated with sudden improvement in glycaemia in pregnancy. Both women were non-compliant with insulin therapy outside pregnancy. The range of medications which can be used to obtain symptom relief is constrained by pregnancy. Ultimately, insulin neuritis is generally reversible after several months of maintained good glucose control. Copyright © 2016 John Wiley & Sons.