“…In summary, hyperglycemia induces spontaneous oxidation of glucose through a variety of enzymatic and non-enzymatic activities, and increases the advanced glycation end products (AGEs), protein kinase C pathway activity, polyol pathway activity (aldose reductase), poly ADP-ribose polymerase (PARP) pathway activity, hexosamine flow, and decreases growth factors, all of which are the key components of the mentioned complex cascade. This pathway finally leads to oxidative stress of nerve cells through stimulating the production of active oxygen and active nitrogen species (30,31). Oxidative stress will eventually cause a lot of neuropathic lesions by activation of many degenerative pathways such as reduction of intracellular antioxidant enzymes activity, vascular damage, increased synthesis of free radicals in the mitochondria, decreased nitric oxide, induced endoneurial hypoxia, apoptosis, degradation of cellular components and increased expression of inflammatory factors (32).…”