Diabetic muscle infarction: An uncommon cause for acute limb
Diabetic muscle infarction (DMI) is one of the unusual complications of poorly controlled diabetes. It is usually seen in association with other microvascular complications. This condition is reported rarely, probably due to it's under recognition.

It is also seen in patients with chronic kidney disease and should be considered in patients presenting with acute onset of limb pain. Published in the Indian Journal of Nephrology, the authors present two cases of DMI in dialysis patients.

#Case 1
A 35-year-old diabetic male with chronic kidney disease (CKD) stage 5 due to biopsy-proven immunoglobulin A nephropathy and on hemodialysis thrice weekly since 14 months presented with acute onset pain of calf muscle in right lower limb, immediately after dialysis session. It was presumed to be muscle fiber tear secondary to intense muscle cramps and he was treated with analgesics. Pain worsened over the week, with patient experiencing severe pain while walking.

A 58-year-old gentleman with diabetes and CKD stage 5 on continuous ambulatory peritoneal dialysis (CAPD) presented with severe pain in the right thigh of 2-day duration. He was on CAPD since 3 years, and was performing four exchanges per day with three exchanges being that of 2.5% glucose and one nocturnal exchange of icodextrin fluid. His glycosylated hemoglobin was 9.7%, with mean blood glucose of 256 mg%.

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