endocrine-pancreas Flashcards
what cells secrete insulin? where in the islets are these cells
insulin
in the center of islets
what receptor does insulin up-regulate on skeletal muscle and adipose tissue
GLUT4
what cells secrete glucagon? what are glucagon’s major functions
alpha cells
increase blood glucose levels via glycogenolysis and lipolysis
what are the two HLA types assoc with T1DM
HLA-DR3 and HLA-D4
what causes T1DM
autoimmune destruction of beta cells by T lymphocytes
stress in a person with poorly controlled T1DM can cause…
why?
diabetic ketoacidosis
epi stimulates glucagon secretion increasing lipolysis (along with gluconeogenesis and glycogenolysis)
lipolysis increase FFA which are converted to ketone bodies
what are the 2 ketone bodies seen in diabetic ketoacidosis
b-hydroxybutyric acid and acetoacitic acid
how does diabetic ketoacidosis present
kussmaul respirations, dehydration, nausea, vomitting, mental status changes and fruity smelling breath (due to acetone)
how does obesity linked to T2DM
obesity leads to decreased numbers of insulin receptors
what are some T2DM glucose measurements for the diagnosis
random glucose
fasting glucose
glucose tolerances test
random glucose >200 mg/dL
fasting glucose >126 mg/dL
glucose tolerances test greater than 200 mg/dL two hours after glucose loading
if T2DM don’t really get diabetic ketoacidosis, what type of serious complication are you worried about
hyperosmolar non-ketotic coma
very high glucose levels can lead to life threatening diuresis with hypotension and coma
what is the leading cause of death in ppl with DM
cardivascular disease
what does non-enzymatic glycosylation of small vessels (arterioles) cause
hyaline arteriolosclerosis
tell me about the NEG on the small vessels of the kidney
perferential hyaline atherosclerosis on the efferent arterioles leads to glomerular hyperfiltration injury with microalbuminuria that will eventually progress to nephrotic syndrome (will see kimmelstiel wilson nodules in glomeruli)
what enzyme converts glucose to sorbital
aldose reducatse
list some consequences to the osmotic damage seen in DM
peripheral neuropathy, impotence, blindness & cataracts
tumors of islet cells are assoc with what syndrome
MEN1
besides tumors of islet cells, what 2 other things do you seen in MEN1
the 3 Ps
pancreatic neoplasm
parathyroid hyperplasia
pituitary adenoma
how do you diagnose an insulinoma
decreased serum glucose
increased insulin
increased c-peptide
what tumor
“presents with treatment resistant peptic ulcers (zollinger-ellison syndrome”
gastrinomas
what tumor
“presents as achlorhydria and cholelithiasis with steatorhea”
somatostatinomas
why does somatostatinomas cause achlorhydria
due to inhibition of gastrin
why does somatostatinomas cause cholelithiasis with steatorrhea
inhibition of CCK
what are the 3 presenting symptoms of VIPomas
watery diarrhea
hypokalemia
achlorhydria
