Causes of pain in joints in Diabetics

by Allan Sandlin
(Canton Michigan, Wayne county)




Question: What Could Cause Severe Joint Pain After Sepsis and ICU Care?



By Allan Sandlin (Canton, Michigan, Wayne County)



I have shoulder, back and knee pain since I got out of the hospital. It is really bad.



I was put into a medically induced coma by the doctors and had to be put on a ventilator. I had pneumonia, acute renal failure, acidosis and septic shock.



That is when I found out I have type 2 diabetes. I am 58. I take amlodipine 10 mg, 56 mg iron, metformin 500 mg and methadone 10 mg.



What could be causing the pain, and what should I do?




Quick answer: Severe shoulder, back and knee pain after pneumonia, septic shock, ventilation and a prolonged hospital stay needs prompt medical assessment. Possible causes include post-sepsis symptoms, ICU-acquired muscle weakness, loss of conditioning, pressure or positioning injuries, nerve problems, arthritis, gout, electrolyte abnormalities or medication effects. Diabetes or amlodipine should not automatically be assumed to be the only cause.




Answer



Hi Allan,



Your recent illnesses were extremely serious. Recovery from sepsis and intensive care can take weeks or months. The CDC notes that sepsis survivors may experience muscle and joint pain, weakness, fatigue, sleep problems and other lasting effects. Your pain deserves a proper examination rather than being attributed to diabetes alone.



One important clarification is that pneumonia can trigger sepsis, and sepsis or shock can then contribute to kidney failure and acidosis. Severe illness can also raise blood glucose and sometimes leads to previously unrecognized diabetes being discovered. The information provided does not prove that diabetes directly caused the septic shock or acidosis.



Possible Causes of Your Pain




  • Post-sepsis syndrome: Muscle and joint pain, fatigue, poor sleep and reduced physical ability can remain after the infection has resolved.

  • ICU-acquired weakness: Critical illness, inflammation, prolonged bed rest and ventilation can cause rapid muscle loss or injury to muscles and nerves. This may produce widespread pain, weakness and difficulty with normal activities.

  • Deconditioning or positioning injury: Immobility during a coma may aggravate the shoulders, back and knees. Tendons, bursae and joints can become stiff and painful.

  • Nerve pain: Diabetes can cause neuropathy, but neuropathy more often causes burning, tingling, numbness or electric pain than swelling inside several joints.

  • Arthritis, bursitis or a spine problem: Osteoarthritis, an inflamed shoulder tendon, a pinched nerve or another musculoskeletal condition may have become more noticeable after hospitalization.

  • Gout or another inflammatory condition: Kidney dysfunction can increase the risk of uric-acid buildup. A hot, red, swollen and very tender joint needs urgent assessment.

  • Blood or chemical abnormalities: Kidney problems, anemia, abnormal calcium, magnesium or phosphate, thyroid disease, vitamin deficiencies or muscle injury may contribute.

  • Medication effects: Amlodipine may cause ankle or leg swelling and, less commonly, muscle stiffness or related symptoms. However, widespread
    severe pain should not be blamed on amlodipine without evaluating other causes. Ask whether medicines received in the hospital, including steroids or certain antibiotics, could be relevant.



What to Do Now



Please arrange an appointment promptly with your primary doctor or the team overseeing your recovery. Bring your hospital discharge summary and a complete list of current and recently stopped medicines. Explain where the pain is located, whether it feels muscular, inside the joint or like nerve pain, and whether you also have weakness, swelling, fever, morning stiffness or difficulty walking.



Your clinician may check joint movement, muscle strength, reflexes, sensation and walking. Depending on the findings, useful tests may include kidney function (creatinine and eGFR), electrolytes, blood count, creatine kinase, and markers of inflammation. Vitamin D, vitamin B12, thyroid tests, uric acid or imaging may be appropriate in selected cases.



If it is medically safe, supervised physical therapy or rehabilitation may help rebuild strength and movement after intensive care. Begin activity gradually and follow professional guidance; pushing through severe or unexplained pain is not advisable.



Medication and Kidney Safety




Do not stop or change amlodipine, metformin or methadone by yourself. Because you recently had acute renal failure, your current kidney function should be confirmed. Metformin is cleared through the kidneys, and treatment must be reviewed when kidney function is significantly reduced or during serious illness or dehydration.




Do not start ibuprofen, naproxen or another anti-inflammatory pain reliever without asking your clinician, because these medicines may worsen kidney function or blood pressure in some people. Methadone also needs careful prescriber supervision and should not be abruptly stopped or combined with alcohol or sedating medicines unless specifically approved.



When to Seek Urgent Help




Seek urgent medical care now if you have any of the following:



  • fever or chills with a hot, red or rapidly swelling joint;

  • new shortness of breath, chest pain, confusion or extreme drowsiness;

  • very little urine, rapidly increasing swelling or dark, cola-colored urine;

  • new or worsening weakness, inability to walk, loss of bladder or bowel control, or numbness around the groin;

  • severe high blood sugar with vomiting, abdominal pain, rapid breathing, dehydration or positive ketones.


If none of these warning signs is present, the severity and duration of your pain still justify a prompt medical appointment.




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Medical References





Written by Dr. Albana Greca Sejdini, MD, MMedSc

Medically reviewed by Dr. Ruden Cakoni, MD, Endocrinologist

Last reviewed: July 2026



Medical disclaimer: This information is educational and does not replace an examination, diagnosis or treatment from your healthcare professional. Seek emergency help for severe or rapidly worsening symptoms.



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