The pancreatic  cell can respond in the long term to hyperglycemia both with an increased capacity for insulin production and, in susceptible individuals, with apoptosis. When glucose-induced apoptosis offsets the increasing  cell capacity, type 2 diabetes results. Here, we tested the idea that the pathway of glucose metabolism that leads to the modification of intracellular proteins with the O-linked monosaccharide N-acetylglucosamine (O-GlcNAc) is involved in the glucose-induced apoptosis. This idea is based on two recent observations. First, the  cell expresses much more O-GlcNAc transferase than any other known cell, and second, that the  cell-specific toxin, streptozotocin (STZ), itself a GlcNAc analog, specifically blocks the enzyme that cleaves O-GlcNAc from intracellular proteins. As a consequence, we now show that hyperglycemia leads to the rapid and reversible accumulation of O-GlcNAc specifically in  cells in vivo. Animals pretreated with STZ also accumulate O-GlcNAc in their  cells when hyperglycemic, but this change is sustained upon re-establishment of euglycemia. In concert with the idea that STZ toxicity results from the sustained accumulation of O-GlcNAc after a hyperglycemic episode, we established a low-dose STZ protocol in which the  cells' toxicity of STZ was manifest only after glucose or glucosamine administration. Transgenic mice with impaired  cell glucosamine synthesis treated with this protocol are resistant to the diabetogenic effect of STZ plus glucose yet succumb to STZ plus glucosamine. This study provides a causal link between apoptosis in  cells and glucose metabolism through glucosamine to O-GlcNAc, implicating this pathway of glucose metabolism with  cell glucose toxicity.T he pancreatic  cell is the primary regulator of glucose flux into stored energy in vertebrates. To accomplish this function,  cells must sense the plasma glucose concentration and secrete the appropriate amount of insulin to direct glucose uptake and storage of its chemical energy in the fat, muscle, and liver. Considerable progress has been made in the understanding of glucose sensing by the  cell. Glucose enters the  cell through the GLUT2 glucose transporter (1), and it is phosphorylated by glucokinase, which has a K m for glucose that allows substantial glucose phosphorylation to proceed only when plasma glucose concentrations exceed 5 mM (2). Once glucose is phosphorylated, it can enter a variety of metabolic pathways, including glycolysis. An increased ATP͞ADP from glucose metabolism generally is believed to regulate the immediate release of insulin (3, 4). The normal  cell is also capable of adapting its capacity for insulin release depending on long-term nutritional status. For example, exposure to a higher than normal carbohydrate load can condition the  cell to secrete even more insulin after exposure to the same load several hours later (5). Finally, the  cell is capable of even more long-term adaptation by increasing the  cell number through hyperplasia (6, 7). However, this hyp...