A 71-year-old man with type 2 DM for the past 12 years presented at the clinic with an HbA1c level of 10%. The patient had previously experienced progressive lower extremity weakness, GIT bleeding, shooting-type pains, numbness and tingling in both feet. He had undergone a loss of appetite with a loss of approximately 50 kgs. In addition, the left lower extremity showed atrophy of the quadriceps and hamstring muscles. Left leg strength was 2/5 for hip flexion and 3/5 for plantar flexion. The right lower extremity strength was 4/5 throughout.
The sensation was decreased to pinprick and temperature to the mid calves bilaterally with distal decreased vibratory sensation. No Reflexes were seen at the ankles and knees. Bilateral lower extremities nerve conduction studies demonstrated absent sensory and motor responses. EMG demonstrated diffuse subacute neurogenic changes in multiple muscles (tibialis anterior, gastrocnemius, and vastus lateralis), including the thoracic and lumbar paraspinal muscles. Over time, the HbA1c level of the patient improved to 6.1%, and he gradually regained strength in the left leg.
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