Rapid Glycaemic Control Leading to Painful Neuropathy: A Case of Treatment-Induced Neuropathy of Diabetes in a Young Patient

Abubakr Sowilem,1 Hebatallah Nasser Fadhl,2 Muhammad Taha Zaman,3 Shatha Ahmad Alhawawreh,4 Shehab Hashem Elsoghier,5 Preeny Treesa Pauly,6 Mohammed Ali Saghir7,81Department of Endocrinology, Al Sabah Hospital, Kuwait City, Kuwait; 2Faculty of Medicine, Al-Fajr College for Science and Technology, Khartoum, Sudan; 3Coventry University, Coventry, UK; 4Jordan University of Science and Technology (JUST), Irbid, Jordan; 5Faculty of Medicine, Modern University for Technology & Information (MTI), Cairo, Egypt; 6Sarat Abeidha General Hospital, Aseer Cluster, Sarat Abidah, Saudi Arabia; 7Faculty of Medicine and Health Sciences, University of Saba Region, Marib, Yemen; 8Epidemiology and Public Health, Graduate College, University of Bahri, Khartoum, SudanCorrespondence: Mohammed Ali Saghir, Faculty of Medicine and Health Sciences, University of Saba Region, Marib, Yemen, Tel +967775133235, Email moh.saghir2019@gmail.comIntroduction: Intensive glycaemic control is essential for managing Type 1 Diabetes Mellitus (T1DM), yet rapid metabolic optimization can trigger Treatment-Induced Neuropathy of Diabetes (TIND). This iatrogenic condition, characterized by acute neuropathic pain and autonomic dysfunction, is increasingly relevant with the use of advanced automated insulin delivery (AID) systems.Case Presentation: A 19-year-old male with a 10-year history of poorly controlled T1DM (baseline HbA1c 13.7%) was transitioned to an automated hybrid closed-loop system (Medtronic MiniMed 780G). Following a rapid HbA1c reduction of 6.3% over six weeks, the patient developed severe, "electric shock-like” neuropathic pain in the lower limbs and upper back without associated autonomic nervous system involvement. Nerve conduction studies confirmed a length-dependent sensorimotor axonal polyneuropathy. The patient’s pain was refractory to duloxetine but showed significant improvement with gabapentin alongside clinical recovery observed over 4 weeks. To stabilize glucose levels, the AID system was discontinued in favor of a less intensive multiple daily injection (MDI) regimen.Conclusion: Rapid glycemic correction in patients with high baseline HbA1c carries a significant risk of TIND. Clinicians should consider close monitoring and individualized adjustment of blood glucose descent in high-risk individuals, even when utilizing advanced AID systems, to prevent debilitating neurological complications.Keywords: diabetes mellitus, glycemic control, neuropathic pain, iatrogenic and automated insulin delivery