Diabetic neuropathic cachexia and acute bilateral cataract formation following rapid glycaemic control in a newly diagnosed Type 1 diabetic patient

In patients with Type 1 diabetes mellitus (DM), the development of complica tions within the first few years of diagnosis is very unusual and the devel opment of complications within weeks of commencement of insulin therapy is exceptional. Diabetic neuropathic cachexia, unlike the other more common ne uropathies associated with diabetes, is a rare form of peripheral neuropath y characterized by profound weight loss, painful dysaesthesias over the lim bs and trunk with spontaneous resolution usually occurring within a year. T he morphologically distinct diabetic or metabolic cataract in patients with newly diagnosed Type 1 DM is also a rare complication. We describe the fir st case of a young man with newly diagnosed Type 1 DM who developed these t wo rare complications within 3 months of diagnosis and insulin therapy comm encement. Rapid development of complications in this patient raises two pos sibilities, i.e. a probable link between the pathophysiology of these two c omplications following rapid glycaemic control, and a subset of patients wi th unusual susceptibility to complications. We re-emphasize the need for vi gilant monitoring of complications in young diabetic patients, even in the first few years of their disease. In particular, young patients with visual impairment should be evaluated carefully for evidence of treatable eye com plications.