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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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