MRCP UK EXAMINATIONS

Detailed explanation-1: -Small-diameter nerve fibers represent 70–90% of all peripheral nerve fibers and are believed to be the earliest fibers to be damaged in diabetes (1). Small-fiber injury has also been associated with neuropathic pain (2, 3), which is one of the most disabling symptoms in patients with diabetic neuropathy.

Detailed explanation-2: -Patients suffering from diabetic neuropathy experience abnormal sensations and have damage in their peripheral nerve axons as well as myelin, a tightly packed Schwann cell sheath that wraps around axons to provide insulation and increases electrical conductivity along the nerve fibers.

Detailed explanation-3: -Loss of ankle reflexes occurs early in diabetic neuropathy; thus, initial examination should include reflex testing. Later, weakness of small foot muscles and dorsiflexors is observed.

Detailed explanation-4: -Vitamin C plays a synergistic role in reducing pain in patients with diabetic neuropathy. It improves QOL due to its analgesic properties.