Treatment-induced neuropathy of diabetes (TIND) is a rare but potentially painful complication of diabetes caused by high blood sugar and nerve damage.
Treatment-induced neuropathy of diabetes (TIND) is a little-known complication of diabetes that may affect up to 10% of individuals with diabetes.
This acute condition occurs due to aggressive glucose-lowering therapy in people with established diabetes who have a history of less effective blood sugar management.
This article will explain the signs and symptoms of the condition, as well as diagnosis protocols and treatment.
Learn more about neuropathy of diabetes.
What is treatment-induced neuropathy of diabetes (TIND)?
Like neuropathy of diabetes, in which people experience weakness, pain, and numbness due to nerve damage (from prolonged high blood sugar levels), usually in the hands and feet, TIND presents similarly, with burning and stabbing neuropathic pain.
TIND (also called insulin neuritis) begins abruptly between 2 and 6 weeks after the improvement of glycemic management. According to a study from 2015 , it can be associated with autonomic symptoms and rapid worsening of other microvascular complications.
What are the symptoms of treatment-induced neuropathy of diabetes (TIND)?
In the earliest stages, neuropathy may come with no symptoms at all, but as the condition progresses, symptoms may include:
If you live with diabetes and are experiencing any of the symptoms of diabetic neuropathy, contact a doctor immediately.
What causes treatment-induced neuropathy of diabetes (TIND) ?
The cause of neuropathy of diabetes is prolonged high blood sugar levels (ineffective glycemic management) over a long period of time. This is a common complication of diabetes, affecting as many as 50% of people living with diabetes.
But the cause of TIND is a little tougher to pinpoint.
It occurs after a rapid improvement in blood sugar levels in people who have a history of hyperglycemia in diabetes. Typically, this would mean a drop in A1C of two or more percentage points over a 3-month period.
Language matters
In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article .
What are the risk factors for treatment-induced neuropathy of diabetes (TIND)?
The risk factors for TIND are the following:
- having diabetes (either type 1 or type 2)
- having a history of high blood sugar (hyperglycemia)
- having had diabetes for at least 5 years
- being assigned male at birth (slightly more likely to experience the condition than people assigned female at birth)
- having a history of insulin use
How is treatment-induced neuropathy of diabetes diagnosed (TIND)?
This condition is vastly underdiagnosed. Doctors can make a diagnosis based on symptoms and by reviewing your medical history as well as undertaking a physical exam, but a diagnosis is often made by excluding other reasons for symptoms.
A doctor will likely check your reflexes, muscle strength, and tone, as well as your sensitivity to touch, pain, and vibration.
The following tests may be performed to diagnose this condition:
How is treatment-induced neuropathy of diabetes treated (TIND)?
Although there’s no cure for this condition, stabilizing blood sugar levels is the top way to treat it and prevent its progression. Over time, with the stabilization of blood sugar levels, people may see a gradual elimination of pain.
Additionally, treatment is aimed at pain relief and managing complications for the person and usually involves the same medications used for the treatment of neuropathy of diabetes.
Pain-relieving medications may include:
- antiseizure medications, such as pregabalin ( Lyrica )
- antidepressants, like nortriptyline ( Pamelor )
- serotonin or norepinephrine reuptake inhibitors
- over-the-counter (OTC) medications like acetaminophen or ibuprofen
For people with established diabetes, prevention is key, and tight blood sugar management should be paramount.
Other preventive strategies to employ include:
- Work with a doctor to make sure you’re meeting your time in range and A1C goals.
- See a doctor, podiatrist , or both regularly for foot checks.
- Keep your blood pressure in a healthy range.
- If you smoke, try to quit.
- Try to make healthy food choices.
- Try to be active every day.
- Check your feet and lower legs daily for any signs of infection (discoloration, swelling, etc.).
- Always wear shoes when walking outside.
- Don’t allow shoes to be worn inside your home.
- Prevent skin cracking by using lotion regularly.
- Take care of your toenails, keeping them clean and cut short.
- Wear well-fitting shoes that aren’t too tight or loose.
- Wear clean, dry socks with all shoes.
What’s the outlook for people with treatment-induced neuropathy of diabetes (TIND)?
For some people, TIND is temporary, treatable, or both. Depending on severity, for other people, it may be permanent and incurable.
Your outlook will depend on the severity of your condition, your medical history, and how quickly you get treatment.
Frequently asked questions
How long does treatment-induced neuropathy of diabetes last?
Everyone is different. This extremely painful condition is often resistant to treatment. But symptoms of TIND can gradually improve within weeks to months of initial onset. It’s important to get treatment early to have better health outcomes.
Can you reverse neuropathy of diabetes?
No, you can’t reverse nerve damage (neuropathy). Treatment is based on pain relief for the person and the prevention of the condition progressing. With treatment, many people can see their symptoms improve and pain decrease.
Takeaway
TIND is a little-known complication of diabetes that has a rapid onset due to the abrupt lowering of blood sugar levels after a history of prolonged high blood sugar levels.
TIND occurs in people with established diabetes and might affect as many as 10% of all people with diabetes. People who have a history of less effective glycemic management are the most likely to be affected by this condition.
TIND can’t be cured, but symptoms may gradually improve within weeks or months of treatment. Treatment should focus on pain management and preventing the condition from worsening.
Talk with a doctor if you’re experiencing burning, pain, tingling, or loss of sensation in your extremities and you live with diabetes. These may be symptoms of neuropathy.
If you’ve experienced a sudden drop in your A1C (1% or more within a month) and you have symptoms of TIND, contact a doctor immediately.
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