Objective: Tremor is the most common type of involuntary movement. Clinically tremor can be classified into physiological, essential, dystonic, Parkinsonian and psychogenic. Risk for hand tremor increases with age and can also be influenced by diseases including diabetes. Type 1 diabetes is the autoimmune form of diabetes and often arises in childhood.

Background: A 26-year-old female was diagnosed type 1 diabetes 20 years ago. Since then she has received insulin. Over time dose of insulin is increased. She complains of numbness, tingling and burning sensation, cramps, pains, muscle weakness, mood decline. In recent years she started complaining of hand tremor which increases and limits her daily activities. She can’t use alcohol because tremor gets worse.

Methods: Laboratory and hormonal analyses were performed. In neurological status she has loss of tendon reflexes, especially in the ankle, loss of balance, coordination, paresthesias.

Results: She was diagnosed with diabetic polyneuropathy with high-level glucose in blood. The cause of tremor, which is axonal polyneuropathy, is constant thus tremor cannot be stopped using b-blockers, clonazepam, or alcohol.

Conclusions: Tremor can be not only associated with damage of basal ganglia, as well as can be associated with peripheral damage of nerves (polyneuropathy). This type of tremor is more constant and often not amenable to drug treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/insulin-dependent-diabetes-and-hand-tremor/