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Under-recognised paradox of neuropathy from rapid glycaemic control
  1. M K S Leow1,
  2. J Wyckoff2
  1. 1Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore
  2. 2Joslin Clinic, Joslin Diabetes Center, Harvard Medical School, USA
  1. Correspondence to:
 Dr M K S Leow
 Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, Singapore 308433;


Insulin induced neuropathy has been reported previously in people with diabetes treated with insulin, and subsequently reported in patients with insulinomas. However, neuropathy caused by rapid glycaemic control in patients with poorly controlled diabetes with chronic hyperglycaemia is not a widely recognised entity among clinicians worldwide. It is expected that this phenomenon of paradoxical complication of neuropathy in the face of drastic decreases in glycosylated haemoglobin concentrations will assume greater importance with clinicians achieving glycaemic targets at a faster pace than before.

  • HbA1c, glycosylated haemoglobulin
  • DCCT, diabetes control and complications trial
  • UKPDS, United Kingdom prospective diabetes study
  • HIF-1α, hypoxia inducible transcription factor-1α
  • HIF-2α, hypoxia inducible transcription factor-2α
  • glycaemic control
  • neuropathy
  • insulin neuritis
  • glycosylated haemoglobin
  • hypoglycaemic sensorimotor neuropathy
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  • Funding: none.

  • Competing interests: none.

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