A Fast Drop in HbA1c Levels Linked to Neuropathy

Diabetic neuropathy is a complication of both type 1 and type 2 diabetes. It is usually the result of nerve damage caused by hemoglobin A1c (HbA1c) values that remain high for a long period. Neuropathy symptoms typically include pain, loss of sensation or tingling in the extremities. 

However, there are some cases of diabetic neuropathy that are caused by a very fast drop in HbA1c levels (i.e., higher than 2% in three months). This type of neuropathy, called treatment-induced neuropathy of diabetes, or TIND, is still largely unknown and rarely studied.

Occurrence and symptoms

A study led in a neurological clinic sought to quantify the number of TIND cases among its diagnosed neuropathy cases. The researchers found that about 10% of all neuropathy cases diagnosed in this clinic met the diagnostic criteria for TIND. 

They also found that about 60% of people whose HbA1c dropped by 2% or more over a three-month period developed TIND. The researchers discovered that people with type 1 diabetes (T1D) and those among them who have a history of eating disorder were at higher risk for developing this type of neuropathy. 

The causes of nerve damage have not yet been fully established, but the study suggests that TIND might be the result of inflammation caused by hypoglycemia episodes, which in turn are associated with a fast drop in HbA1c levels. Researchers also reported that pain in the extremities or central pain is common to all individuals with this type of neuropathy. The majority felt intense pain within two to six weeks of the improvement in their blood sugar levels. Other reported symptoms included dizziness and loss of consciousness.   

The authors of the study noted that TIND can be reversible for some people, particularly those with type 1 diabetes.


A drop of 2% or more in HbA1c levels over a three-month period usually implies significant lifestyle changes. If you and your healthcare team are looking to reduce your HbA1c levels, make sure you discuss safe and durable strategies for reaching this goal.   

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  • Christopher H. Gibbons, Roy Freeman, Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes, Brain, Volume 138, Issue 1, January 2015, Pages 43–52, https://doi.org/10.1093/brain/awu307

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