Treatment-induced neuropathy of diabetes (TIND): a hidden complication in diabetes management

Treatment-induced neuropathy of diabetes (TIND) is an under-recognised complication that arises after rapid glycaemic control in diabetic patients. It presents with acute autonomic dysfunction and/or neuropathic pain resulting from small fibre nerve damage. This case involves a woman in her 50s with type 2 diabetes who transitioned from oral hypoglycaemic agents to insulin therapy, leading to a significant drop in HbA1c from 10% to 7.2% within the last 3 months. She presented with painful sensations, orthostatic hypotension and syncope. A diagnostic workup revealed peripheral nerve and autonomic dysfunction. Symptomatic treatment, including pregabalin and intravenous fluids, led to symptom resolution. This case highlights the importance of recognising TIND in patients with rapid glycaemic control to prevent unnecessary interventions. Awareness and appropriate management, including gradual glycaemic correction, can significantly improve patient outcomes.