We report a case of acute, painful polyneuropathy in a woman with newly diagnosed type I diabetes mellitus associated with a precipitous drop in hemoglobin A1c . She has had poorly controlled diabetes mellitus type I for 5 years despite diet, execise, oral therapy because she has been diagnosed type II diabetes mellitus 5 years before. She experienced diabetes ketoacidosis, and she presented with a hemoglobin A1c of 17.8% and was hospitalized for continuous subcutaneous insulin infusion. Following the initiation of continuous subcutaneous insulin infusion, the patient's hemoglobin A1c fell to 6.1% within 2 months. During this 2-month period, she developed severe burning in her hand, feet and trunk, accompanied by tingling paresthesia and dysesthesia. Nerve conduction studies were consistent with mild sensorymotor peripheral neuropathy. Initially, she required opiate analgesics for pain control because gabapetin or tramadol/acetminophen did not help. Three months after presentation, the patient showed dramatic improvement and her pain resolved. Although not well described in the neurologic literature, this case represents insulin neuritis, one of the few diabetic neuropathies that has a favorable outcome. (J Korean Acad Fam Med 2008;29:283-286)
인슐린 신경염(Insulin neuritis)은 당뇨병 환자에게 초기 치료방법으로 Insulin을 사용하여 급격하게 혈당을 정상으로 교정하였을 때 급성으로 심한 통증을 동반하여 발생하는 신경병증이다. 임상 증상으로는 타는 듯한 통증(burning pain), 이상감각(paresthesia), 이질통(allodynia) 등을 보이고, 심한 통증으로 인하여 일상생활 등을 정상적으로 하지 못하는 경우가 흔하다. 저자들은 온 몸이 망치로 맞은 것처럼 살갗이 아프고, 따가운 증상으로 내원한 27세 여자에서 혈당 조절을 위한 Insulin 치료 후, 급성으로 심한 통증을 동반한 당뇨병성 신경병증이 발생한 환자를 경험하였기에 증례로 보고한다.
