In type 2 diabetes, glutamine fructose-6-phosphate amidotransferase (GFAT) is involved in insulin resistance and hyperinsulinemia, while the end product of this pathway, uridine-5-diphosphate-N-acetyl glucosamine, causes gene transcription factor specificity protein 1 (Sp1) to increase which then activates the transforming growth factor beta (TGF-β) and plasminogen activator inhibitor-1 (PAI-1), responsible for damaging endothelial cells and prompting smooth muscle cell division. The gene discussed is SERPINE1; the disease is hyperinsulinism.