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November 7, 1966

Diabetic Angiopathy and L-xylulose

Author Affiliations

From St. Lukes Hospital, San Francisco. Dr. Shaw is now with the Department of Psychiatry at Massachusetts General Hospital, Boston.

JAMA. 1966;198(6):665. doi:10.1001/jama.1966.03110190147043

A POSSIBLE MECHANISM for the origin of diabetic angiopathy through insulin deficiency has been postulated by Spiro.1 He suggests that glucose utilization may be diverted into insulin-independent pathways with resulting formation of excess glycoprotein. Winegrad and Burden2 demonstrated a persistently increased serum level of L-xylulose, a nonphosphorylated intermediate in the glucuronic acid pathway, in diabetic patients. This increase had no apparent relation to blood glucose levels. In addition, they demonstrated that insulin produced a consistently prompt fall in the serum L-xylulose levels in diabetic patients. This report describes a patient with minimal impairment of glucose tolerance, but with severe diabetic angiopathy and a high serum level of L-xylulose.

Report of a Case  A 52-year-old Spanish man was tested for diabetes five years ago because of an ischemic ulcer on the left great toe. His glucose tolerance curve showed a fasting glucose level of 93 mg/100 ml, at 30

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