Don't forget your hammer if you want to go to work!

Summary

Bilateral lower limb paraesthesia is a common diabetic neuropathy presentation in any busy diabetic clinics. We present a case of a 28-year-old man with a long history of type 1 diabetes mellitus presented with bilateral paraesthesia of both feet and unsteady gait. The patient was able to feel a 10 g monofilament. The presence of brisk reflexes and upgoing plantars in this patient were pointers that further evaluation was warranted. Further investigations revealed diagnosis of subacute combined degeneration of spinal cord. The patient had rapid symptomatic improvement with i.m. vitamin B12 injection. The high volume of patients attending the outpatients with diabetes and paraesthesia can blind us to other possible diagnoses. This article emphasizes that peripheral neuropathy in a diabetic may be due to aetiologies other than diabetes.

Learning points

• Pernicious anaemia is known to be more common in patients with type 1 diabetes.

• Cobalamin deficiency is reversible if detected early enough and treated by B12 replacement.

• By contrast, diabetic neuropathy is generally a progressive complication of diabetes.

• Peripheral neuropathy in a diabetic may be due to aetiologies other than diabetes.