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Med Sci Sports Exerc 37(3):374380 Gleeson M, McDonald WA, Pyne DB, Cripps AW, Francis JL, Fricker PA et al (1999) Salivary IgA levels and infection risk in elite swimmers

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The hexosamine pathway is activated by high blood sugar levels, which causes damage to Schwann cells and nerve cells through inflammation and oxidative stress, eventually leading to diabetic peripheral neuropathy (DPN)

These changes correlated with increased carnitine acetyl transferase (CrAT) protein and enzyme activity and decreased levels of nitrated CrAT