Dramatic Response of Painful Peripheral Neuropathy with Insulin Pump in Type 2 Diabetes
Abstract Number: 2097-PO
Authors: JOTHYDEV KESAVADEV, SABEER A. RASHEED, Trivandrum, Kerala, India
Results: Painful peripheral neuropathy is difficult to treat due to its non responsive nature to a wide spectrum of currently available drugs. There are no standard treatment guidelines advocating the use of insulin pump for the management of this situation. However, continuous subcutaneous insulin infusion (CSII) is highly effective in alleviating the severe pain due to this condition. Here we are documenting a case report in which a type 2 diabetic patient with severe painful neuropathy of both lower extremities who readily responded to insulin pump therapy. A 58 year old gentleman with diabetes for the past 20 years registered with our hospital with the intention to treat his painful neuropathy affecting both lower limbs. He was an Asian Indian in origin settled in Europe for the last 25 years. On examination he had BMI 20.89 kg/m2, BP 130/80mmHg, A1c 10%, serum creatinine 1 mg, and had mild non proliferative diabetic retinopathy of both eyes. The patient was severely depressed and sick which he attributed to the severe burning pain in his lower limbs which was seriously interfering with his day to day activities. He gave history of being administered with various insulin preparations and also had several drugs for neuropathic pain but had no relief at all. We suggested CSII through an insulin pump and the same was deployed within a week after obtaining his 3 days continuous glucose monitoring system recording. By the sixth day he started revealing definite signs of improvement without any concomitant use of medicines for neuropathic pain and by the tenth day his pain almost disappeared which never had happened before even with the use of various medications including multiple daily insulin shots. After 25 days of initiating insulin pump therapy he flew back to his country and was put on weekly tele followup. The dosage of insulin was titrated once in every 3 days based on the blood sugar values reported by the patient. The relief of pain remained consistent and resulted in incredible improvement in his physical quality of life. Insulin pump therapy is a proven and effective method in both type 1 and insulin requiring type 2 diabetic patients. The dramatic response of refractory painful diabetic neuropathy to CSII as observed in this case should be studied further in randomized controlled trials so as to evolve treatment recommendations for this clinically challenging disorder.