Treatment-Induced Neuropathy of Diabetes (TIND)
- jenhrn98
- 12 hours ago
- 2 min read
So, you find out you have diabetes! You get prescribed all the right medications, speak to a dietician, throw away all the sugary foods in your house, buy healthy groceries and maybe even get a gym membership. You are determined to do everything right and get your A1C below 7. But, did you know that lowering your blood sugar too quickly can lead to debilitating nerve pain and autonomic dysfunction?
What is TIND?
TIND is a painful and sometimes debilitating neuropathy that can occur as a result of a rapid drop in blood glucose levels. Using insulin, oral medications, and changing diets can be triggers. It is more common in individuals who have chronic hyperglycemia and attempt to fix their blood sugars (A1C) rapidly. TIND is defined as an acute neuropathy that occurs within 8 weeks of an abrupt decrease in A1C.
Symptoms
Symptoms can include neuropathic pain such as burning, stabbing, "electric" or shooting pain, allodynia which is pain from usually non painful stimuli such as clothing and showering, and hyperalgesia which is an increased sensitivity to painful stimuli. Pain may tend to be worse at night. Sensory changes can also occur such as numbness to pain or temperature mostly in the feet. Autonomic dysfunction such as gastrointestinal issues like bloating, constipation and/or diarrhea, cardiovascular issues and genitourinary problems can also occur.
Diagnosis
There are three clinical criteria that are required for a diagnosis of TIND. They are a drop in HbA1C of at least 2% over 3 months, the acute onset of neuropathic pain and/or autonomic dysfunction within 8 weeks of a rapid improvement of blood sugar levels, and symptoms severe enough to cause the individual to seek medical help. TIND is more likely to occur in individuals who have very poorly controlled blood sugars over a longer period of time. (ie A1C over 10)
Treatment
There is currently no cure for TIND but with symptom management and time, the symptoms can be lessened. Pain medications such as gabapentin can be prescribed. Stabilizing the blood sugar and avoiding large fluctuations will be helpful. There may need to be a team involved ie) Endocrinology, Neurology, and Gastroenterology.
Jennifer Hoar, RN
References:
Baum, P. (2021). Treatment-Induced Neuropathy in Diabetes (TIND) National Institutes of Health NIH. https://pmc.ncbi.nlm.nih.gov/articles/PMC7913916/
(July 2024). What Is Treatment Induced Diabetic Neuropathy? Healthline.
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