The first step in the polyol pathway is the conversion of glucose into sorbitol by aldose reductase. Sorbitol cannot readily cross cell membranes and is therefore trapped inside the cells where it forms.
The second enzyme in the pathway, sorbitol dehydrogenase, is able to convert sorbitol into ☆fructose at a sufficient rate to prevent accumulation when glucose levels are normal.
; in long-standing hyperglycemia, sorbitol accumulates in tissues with lower sorbitol dehydrogenase activity
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