Figure 3: Schematics of branch off pathways of glucose metabolism under hyperglycemic milieu and sequential events influencing myocyte apoptosis and fibrosis resulting in cardiac dysfunctioning. Enzymes involved in the metabolism include - Aldose reductase (AR), Sorbitol dehydrogenase (SDH), Glutamine:fructose-6- phosphate aminotranferase (GFAT), O-GlcNAc transferase (OGT), N-acetylglucosaminidase (O-GlcNAcase).* indicates activation by HMP and AGE products formed.