UNCOMMON EARLY-ONSET NEUROPATHY IN DIABETIC-PATIENTS

An acute neuropathy rarely occurs early in the course of diabetes mell itus. Five cases are described of adult patients who developed a perip heral neuropathy at the time or shortly after the onset or discovery o f diabetes mellitus. Patient 1, an 80-year-old woman who developed a s ubacute tetraparesis with proximal and distal muscle weakness with nor mal cranial nerves, proved to have insulin-requiring diabetes mellitus . In the other patients, all men aged 23-34 years, symptomatic neuropa thy occurred simultaneously (patient 2) or 1-6 months after the onset of insulin-dependent diabetes mellitus (IDDM) (patients 3-5), Patients 2 and 3 developed a symptomatic multifocal neuropathy; patients 4 and 5, a painful distal symmetrical sensory polyneuropathy (DSSP) shortly after beginning treatment with insulin. Nerve biopsy showed active ax onal lesions in patients 2 and 5 and mixed axonal and demyelinating le sions in the others, with severe axon loss in patients 4 and 5. Vascul itic lesions were found in patient 2, who improved without additional treatment. Neurological examination remained unchanged after 2 years i n patients 3-5. Although a coincidence cannot be excluded for patients 1-3, whose neuropathy was not of the pattern commonly found in diabet es, it is suggested that acute disequilibrium in the diabetic status m ay facilitate the occurrence of a variety of neuropathies. Alternative ly, the autoimmune process which led to IDDM may also trigger an autoi mmune neuropathy with vasculitis (patient 2) or demyelinative nerve le sions. Only the distal symmetrical sensory polyneuropathy with severe axonal lesions observed in patients 4 and 5 seems directly related to diabetes mellitus. In spite of their occurrence shortly after beginnin g insulin therapy, the role of treatment with insulin in the onset is uncertain.