Treatment induced neuritis in diabetes (TIND) – Terra incognita in the spectrum of diabetic neuropathies

Abstract

Treatment-induced neuropathy in diabetes (TIND), better known as insulin neuritis, is an uncommon, iatrogenic, small fibre neuropathy occurring with an abrupt betterment in glycaemic control in patients of chronic hyperglycaemia. TIND, as such, is a less reported entity often missed by clinicians on initial presentation, but is an important consideration in patients with rapid correction of their hyperglycaemic status. TIND is characterised by an acute onset length dependent or generalised neuropathic pain often accompanied by autonomic symptoms and signs. This mostly occur after 2-8 weeks of initiating glycaemic control with insulin and is associated with a decline in glycosylated haemoglobin (HbA1c) by ≥2% points over 3 months. In fact, these patients on presentation, have reasonably satisfactory glycosylated haemoglobin profiles, as this condition is seen with acute control of glycaemic status. We herein discuss details of this entity as a review of literature with an overview of its pathophysiology, clinical features, and management.