NICE - painful diabetic neuropathy (neuritis) following improvement in glycaemic control

Acute painful neuropathy of rapid improvement of blood glucose control

• adults with type 1 diabetes that acute painful neuropathy should be reassured resulting from rapid improvement of blood glucose control is a self-limiting condition that improves symptomatically over time
• Explain to adults with type 1 diabetes that the specific treatments for acute painful neuropathy resulting from rapid improvement of blood glucose control:
  • have the aim of making the symptoms tolerable until the condition resolves
  • may not relieve pain immediately and may need to be taken regularly for several weeks to be effective.

First line management

• simple analgesics (paracetamol, aspirin) and local measures (bed cradles) are recommended - but if trials of these measures are ineffective, discontinue them and try other measures
• do not relax diabetes control to address acute painful neuropathy resulting from rapid improvement of blood glucose control in adults with type 1 diabetes

If simple analgesia does not provide sufficient pain relief for adults with type 1 diabetes who have acute painful neuropathy resulting from rapid improvement of blood glucose control

• then manage as per NICE guideline on neuropathic pain - pharmacological management
• simple analgesia may be continued until the effects of additional treatments have been established
  • be aware of risk of dependency associated with opioids
    
    

Reference:

• NICE (August 2015). Type 1 diabetes in adults: diagnosis and management