A case analysis of acute painful neuropathy caused by insulin

ZHANG Qian-ying; TANG Zhi-hui; XIAO Yan-ge

doi:10.3969/j.issn.1672-8157.2018.02.014

Abstract：A 29-year-old male patient without medical history was hospitalized because of severe pain in hands, feet and legs for 2 months. The patient was diagnosed as type 2 diabetes and diabetic perineuropathy. The patient was firstly diagnosed as diabetes and the fasting plasma glucose was reduced from 23.14 mmol·L-1to 6 mmol·L-1after 18 days treatment with isophane protamine biosynthetic human insulin injection (pre-mixed 30R) and glimepiride. The patient developed acute acupuncture-like pain with no obvious incentive. And the pain was slightly relieved after taking pregabalin capsules and ibuprofen and codeine phosphate tablets. After admission, the patient was treated with isophane protamine biosynthetic human insulin injection (pre-mixed 30R) (28 - 34 IU a.j., 18 IU ant.coen), α-lipoic acid injection (600 mg, qd), mecobalamin injection (500 μg, qd), pregabalin capsules (75 mg, bid). The blood glucose of the patient was controlled while pain of limbs persisted and the patient had limited movement. Two days later,epalrestat capsules(50 mg,tid)and Mudan granules(1 bag,tid)were added for painful neuropathy and duloxetine hydrochloride enteric capsules (60 mg, qd) was added for antidepression according to the consultation of psychological department. The pain of limbs was obviously improved. The patient was discharged out without limited movement. The acute painful neuropathy of this patient might be associated with rapid decline of blood glucose caused by insulin.