Introduction: Diabetic neuropathy is often a late manifestation of diabetes. Moreover its incidence in the paediatric age group is very rare. We present here a case of motor neuropathy as a first presenting feature of Type 1 diabetes mellitus.
Case Report: A fourteen-year-old girl presented with right foot drop, which had progressively worsened over the last ten days. There was no other CNS or systemic involvement. Parents denied any history of pain, paraesthesia or loss of sensations. On specific questioning the patient had osmotic symptoms and weight loss over the preceding 2 months. She was noted to have a high stepping gait and was unable to dorsiflex her right foot. Preliminary tests showed blood glucose levels of 24 mmol/l with HbA1c of 118 mmol/mmol. Further investigations revealed positive Islet Cell antibodies, raised Anti GAD and IA2 antibodies-which confirmed type 1 diabetes mellitus. Other investigations including electrolytes, thyroid function tests, full blood count, vitamin D, vitamin B12 and folate levels were all normal. Nerve conduction studies demonstrated a mixture of axonal damage and focal demyelination of right peroneal nerve at the knee. The patient was started on Multiple Daily Injection Insulin Regimen as per protocol and the foot drop recovered within a period of 2 months.
Conclusion: Though diabetic neuropathy is more common in Type 1 diabetes it usually does not manifest until long after onset of diabetes. Whilst it has been reported more frequently in adults we only found one other case report of mononeuropathy as a first presenting feature of diabetes in a child. We present this case to underline the importance of diabetes assessment in otherwise healthy patients presenting with neuropathy. This case also reiterates the fact that improving glucose control rapidly reverses slowing of nerve conduction in diabetes.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes