Chronically high levels of glucose and free fatty acids

Beta cell (in islet of langerhans) desensitization Insulin resistance Increased beta cell secretion of insulin In time however, the insulin declines because of increasing beta cell dysfunction Impaired ability of the body to metabolize glucose

Chronic elevation blood glucose level

Tendency of kidney to excrete excessblood glucose

DM TYPE 2

Decreased cellular uptake of glucose Center of satiety in the brain recognizes body as without glucose sources

Osmotic diuresis Body compensates by increasing intake of glucose sources.

Excess loss of fluid

Increased intracellular concentration of glucose

Increased formation of glycoproteins in the basement membrane of small blood vessels and capillaries

Structural defects in basement membrane and microcirculation

Vascular complication

formation of abnormal blood sugar glycoproteins Diabetic neuropathy damage on the glomeruli Atheroscelosis of blood vessels Decreased function of polymorphonuclear lymphocytes Loss of pain and pressure sensation

decrease GFR

alteration in regulatory process

Impaired circulation, delivery of oxygen and nutrients to cells and retention of metabolic wastes

Blood protein leak in into the urine

Disruption of skin membranes

Stressed kidney filtration mechanism

Infection occurs

Increased pressure of renal blood vessels

Diabetic nephropathy Poor wound healing and cell degeneration Progression of irreversible renal damage

DIABETIC FOOT Retention of uremic waste products

CHRONIC KIDNEY DISEASE