Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the greatest risk for individuals with small nerve fiber neuropathy?

1. Injury from falls due to Charcot foot syndrome

2. Decrease in overall wellness due to limited mobility

3. Risk for sudden cardiac death due to cardiac denervation

4. Foot ulceration and subsequent gangrene and amputation

The correct answer is: Foot ulceration and subsequent gangrene and amputation

Small nerve fiber neuropathy primarily affects the small unmyelinated C fibers and myelinated A-delta fibers that are responsible for transmitting pain and temperature sensations as well as mediating autonomic functions. The damage to these nerve fibers in individuals with diabetes can lead to a decreased ability to feel pain, heat, and cold. This loss of sensation greatly increases the risk of undetected injuries, particularly in the feet, where small cuts, blisters, and other injuries can go unnoticed until they lead to more severe problems. The lack of awareness of injuries can result in foot ulceration, which, if untreated, can escalate into serious infections. This can ultimately progress to gangrene, necessitating potentially life-threatening surgical interventions, including amputation. Consequently, the risk for foot ulceration and subsequent complications is a significant concern for individuals with small nerve fiber neuropathy, making it the greatest risk factor associated with this condition. While other options represent important concerns, such as the potential for impaired mobility or the risk factors for cardiovascular issues, the direct and immediate danger posed by undetected foot injuries leading to ulceration and gangrene is a more pressing risk attributable to the sensory deficits associated with small nerve fiber neuropathy.