1. Insulin & Glucagon are synthesized in pancreatic islet cells Pancreas Small Intestine Pancreatic Duct Acini Cells Islet Cells Alpha Cells: secrete GLUCAGON Beta Cells: secrete INSULIN

2. Muscle Cells uptake glucose from blood Insulin Resistance: Decreased Uptake Insulin Deficiency: Decreased Insulin Production

3. Diabetes: chronically high plasma glucose levels Insulin secreted; excess glucose stored in muscle or fat Insulin not secreted or not effective Excess glucose remains in blood Can only be eliminated via kidney (VERY SLOW)

4. 1) Excess glucose in renal filtrate (glucosuria) 2) Glucose in filtrate draws water away from renal ISF….huge increase in urine volume 3) Decreased blood volume & pressure 4) Circulatory system fails to compensate over time…anaerobic metabolism from dying tissues 5) Metabolic acidosis shuts down CNS 6) DEATH! Diabetes: Multisystem Pathophysiology

5. Amputation in Diabetes Hypovolemia = Root Cause Reduced Blood Flow Impared Healing Low Flow, High Tissue Glucose/Low O2 Rapid, Aggressive Infection Amputation to contain infection