Snapshot A 69-year-old man presents to your clinic with a chief complaint of changes in his vision. He has a past medical history of diabetes mellitus type II and medication non-compliance. The patient states that after a very large meal in which he consumed a family-sized bucket of chicken, a glass of maple syrup, and an entire wedding cake, he noticed that his vision became very blurry. He notes that this tends to happen whenever he eats a large meal. Overview Pathway alternative method of trapping glucose in the cell tissues with sorbitol dehydrogenase liver ovaries seminal vesicles lens (at low level of activity) tissues without sorbitol dehydrogenase Schwann cells retina kidneys note: galactose can also be converted to an aldose see Galactose Metabolism topic Clinical relevance prolonged hyperglycemia commonly caused by uncontrolled diabetes mellitus pathophysiology glucose enters cells and is converted to sorbitol in tissues without sorbitol dehydrogenase or low levels of activity sorbitol trapped in cell and is osmotically active presentation pathology directly linked to which tissues have aldose reductase but lack sorbitol dehydrogenase peripheral neuropathy cataracts retinopathy all symptoms of chronic diabetes sorbitol