Diabetic cachectic neuropathy: An uncommon neurological complication of diabetes.

A 40-year-old female patient with diabetes of 12 years' duration, with poor drug compliance, presented with a 4-month history of rapid progressive weight loss, burning sensations in the feet, abdominal swelling, and constipation with occasional episodes of epigastric pain. On examination, she was chronically ill-looking with a body mass index of 17.1 kg/m2, grossly distended abdomen (initially mistaken for gravid abdomen). Blood pressure measurements in the supine and standing positions were 200/130 mmHg and 180/100 mmHg, respectively. Neurological examination revealed stocking-pattern loss of pain, temperature, and light touch modalities. Vibration sensation was impaired up to the malleoli bilaterally, with impairment of joint position sense of both big toes. Random blood sugar level was 16.4 mmol/L; glycosylated haemoglobin was 13.2% with a haematocrit of 33.0%. Renal indices, uric acid, liver function tests and fasting lipid profile were all within normal limits. An abdominal ultrasound scan showed distended bowel loops. The vibration perception threshold average using biothesiometry was 27.3 mV.