Treatment-Induced Diabetic Neuropathy: A Case Report on Multimodal Pain Management in a Young Patient With Type I Diabetes

Treatment-induced diabetic neuropathy (TIND), also known as insulin neuritis, is a rare but important complication that can occur after rapid correction of chronic hyperglycemia in patients with long-standing diabetes. It manifests as acute, severe neuropathic pain with autonomic dysfunction despite improved glycemic control. Chronic neuropathic pain, which arises from peripheral or central nervous system dysfunction, includes a broad spectrum of conditions such as diabetic neuropathy, trigeminal neuralgia, spinal cord injury, post stroke pain, and radiculopathy. However, TIND remains underrecognized and frequently misdiagnosed. This case report presents a 25-year-old male with type 1 diabetes who experienced two distinct episodes of treatment-induced diabetic neuropathy following periods of rapid glycemic improvement at a tertiary pain management center in the United States. The first episode occurred in 2019 after initiation of intensified insulin therapy, and the second in 2023 following insulin pump placement. Both episodes were characterized by severe bilateral lower extremity burning and stabbing pain despite normal imaging and electrodiagnostic studies. His pain management required a multimodal strategy incorporating pharmacologic therapy (gabapentinoids, antidepressants, and opioids), psychological support, physical therapy, and interventional pain management with lumbar sympathetic blocks. TIND should be considered in patients with unexplained neuropathic pain following glycemic correction. A gradual approach to glycemic control may mitigate its severity. Multimodal pain management, including pharmacotherapy, physical therapy, psychological support, and interventional techniques, plays a crucial role in optimizing outcomes for these patients.