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NBME 24 Answers
A 55-year-old man with type 1 diabetes mellitus ...
Persistent activation of voltage-gated Na+ channels in the nociceptor
I believe this concept is referring to peripheral sensitization. Peripheral nerves that have sustained damage (such as through non-enzymatic glycosylation in DM) cause sensitization of their neighboring nerves, thus leading to lower thresholds for activation. This sensitization is thought to be accomplished through mediators such as PGE2.