Abstract
A 59-year-old woman diagnosed with type 1 diabetes at age 53 (anti-GAD antibody positive at onset) had systemic edema and severe painful neuropathy after insulin use in poor glycemic control (HbA1c 18.2%). She had stopped insulin therapy for 14 months. Her insulin edema appeared within several days of the initiation of insulin aspart three times a day. Severe thoracoabdominal and bilateral thigh pain occurred 6 weeks after insulin initiation. Mexiletine administration was ineffective and she was admitted due to disturbance in daily life. We diagnosed her as having painful posttreatment neuropathy (PPN) with allodynia. After rapid-acting insulin (insulin aspart) was stopped and amitryptirin and dexistrometrufan administration was begun, her PPN rapidly disappeared. Several recent reports on truncal PPN in Japan suggest that this is probably related to increased arteriosclerosis and strict glycemic control using rapid-acting insulin.
