Introduction: Diabetic neuropathy (DN) is a common complication of type 1 diabetes mellitus (T1D) with significant morbidity in adulthood. The association between DN with long term poor metabolic control is well established. However, acute painful DN may present early in the course of the disease and may be reversible.
Case presentation: A female adolescent, aged 12 years, with a T1D duration of 9 months, presented with acute metabolic derrangement (HbA1c:11%) due to eating disorders. She reported omission of meals and insulin doses in an attempt to reduce her weight. The patient complained of numbness and burning sensation in the limbs. Nerve conduction studies (NCS) were indicative of demyelinating deficits in sural and peroneal nerves, which improved within 2 years, with a progressive decline in HbA1c values (7.6%) and the resolution of the eating disorder by psychiatric support. Additionally, an adolescent boy (age: 16 years, T1D duration: 2.5 years), presented with painful DN in the lower limbs, during a period of dramatic deterioration of his metabolic control. During a 4 month period HbA1c values increased from a previous mean of 6.29.5%. NCS depicted demyelination in sural and peroneal nerves. His symptoms resolved and the electrophysiological parameters normalized with intensive follow-up and improvement of HbA1c within 6 months (HbA1c:7.2%).
Conclusions: Acute DN may present in adolescent patients with T1D, early in the course of the disease and may be also associated with eating disorders. Nevertheless, the symptoms and electrophysiological findings can be reversed with the achievement of optimal metabolic control. However, long-standing hyperglycemia can cause permanent nerve impairment. Intensive follow-up is needed to assure that adolescents with T1D maintain a near normoglycemic profile, in order to prevent or even reverse the evolution of DN.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology