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MBBS 2: Endocrine Physiology > Pancreas and Diabetes > Flashcards

Pancreas and Diabetes Flashcards

1
Q

What are the functions of the pancreas?

A
  1. wxocrine 2. endocrine
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2
Q

Describe the endocrine part of the pancreas?

A

produces insulin and glucagon

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3
Q

Where is the pancreas?

A

lies on posterior of the abdominal wall

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4
Q

What cellsproduce insulin and glucagon?

A

islet of Langerhans cells

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5
Q

Functions of insulin?

A
  1. Promotes the up-take of, storage and use of glucose 2. aids entry of amino acids into cells and the production of cellular protein
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6
Q

Insulin is secreted by?

A

beta islets cells when they detect high glucose levels

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7
Q

How does insulin promote glucose entry into cells?

A

through glucose transporters - GLUTS

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8
Q

How much insulin is produced in an adult?

A

45-50 units of insulin each day

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9
Q

What are the types of GLUTs?

A

GLUT 1-6, 8, 9, 11

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10
Q

GLUT1 is expressed in?

A
  1. fetal tissues 2. in adults it is expressed in erythrocytes and endothelial cells of barrier tissues such as blood-brain barrier - responsible for low-level of basal glucose uptake required to sustain respiration in cells
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11
Q

GLUT2 is expressed in?

A
  1. renal tubular cells 2. small intestinal epithelial cells 3. liver and pancreatic beta cells
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12
Q

GLUT3 is expressed in?

A
  1. neurons 2. placenta
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13
Q

GLUT4 is expressed in?

A
  1. adipose tissues 2. skeletal muscle 3. cardiac muscle
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14
Q

GLUT5 is what kind of transporter?

A

fructose transporter

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15
Q

Function of GLUT6?

A

transport glucose out of the endoplasmic reticulum

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16
Q

Describe the actions of insulin?

A

has anabolic effects - promotes the synthesis of larger molecules

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17
Q

Descibe the functions of insulin?

A
  1. increase uptake of metabolites 2. conversion of metabolites to stored forms 3. decreased breakdown of stored metabolites 4. recruitment of glucose channels to the cell membrane e.g. GLUT 4 5. use of glucose for energy over other metabolites
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18
Q

What is the half life of circulatory insulin?

A

4 hours

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19
Q

What breaks down insulin?

A

insulinases in the liver, kidney and placenta

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20
Q

How does insulin work in glucose uptake?

A

binds to IRS stimulates intracellular signaling and activates GLUT 4 which causes glucose uptake - can bind to IRS-1 or IRS-2

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21
Q

Describe the action of insulin in muscle cells?

A
  1. stimulates glucose uptake 2. stimulates glycogenesis (glucose - glycogen) 3. stimulates glycolysis (glucose - energy) 4. atimulates amino acid uptake and protein synthesis 5. inhibits glycogenolysis (glycogen - glucose) 6. inhibits proteolysis (protein - amino acids)
22
Q

Describe the action of insulin in adipose cells?

A
  1. atimulates glucose uptake 2. stimulates lipogenesis (glucose - fatty acids) 3. inhibits lipolysis (fatty acids - energy)
23
Q

Describe the action of liver cells?

A
  1. stimulates glycogenesis (glucose - glycogen) 2. inhibits glycogogenolysis (glycogen to glucose) 3. inhibits gluconeogenesis (amino acids to glucose)
24
Q

Describe the action of insulin on the hypothalamus?

A

may stimulat satiety - fullness

25
Q

Glucagon is secreted by?

A

alpha cells of the islets

26
Q

When is glucagon released?

A

when blood levels of metabolites are low

27
Q

Describe the actions of glucagon?

A

is a catabolic hormone - promotes breakdown of large molecules

28
Q

Describe the functions of glucagon?

A

has opposite effects of insulin - 1. inhibition of glucose and amino acid uptake 2. breakdown of stored metabolites into useable metabolites 3. use of fatty acids for energy over other metabolites 4. promotes hepatic output of ketone bodies

29
Q

What receptor does glucagon bind to?

A

G-protein-coupled receptor

30
Q

What is the normal blood glucose level?

A

3.5 mmol/L

31
Q

How is glucose homeostasis maintained?

A
  1. Insulin lowers blood glucose by stimulating uptake, metabolism and anabolism 2. Glucagon raises blood glucose by stimulating gluconeogenesis and glycogenolysis
32
Q

Name the hormones that raise blood glucose levels?

A
  1. adrenaline - released in response to stress - inhibits insulin 2. cortisol - released in response to stress - reduces sensistivity to insulin 3. growth hormone - released at night - reduces sensitivity to insulin
33
Q

How do these hormones raise blood glucose levels?

A

stimulate glycogenolysis and gluconeogenesis

34
Q

What is hyperglycaemia?

A

excess glucose in blood - fasting concentration > 7.8 mmol/L

35
Q

Hyperglycaemia is seen in?

A
  1. Diabetes mellitus: a disease caused by insulin deficiency or insulin resistance 2. Glucagonoma: a rare tumour of the alpha cells that secrete glucagon
36
Q

What is hypoglycaemia?

A

a deficiency of blood glucose - a concentration < 2.5 mmol/L

37
Q

What is hypoglycaemia caused by?

A
  1. Overtreatment of diabetes mellitus, either excess insulin or beta cell stimulating drug 2. Non-diabetic disorder causing fasting Hypoglycaemia 3. Idiopathic excessive insulin secretion causing Hypoglycaemia after glucose ingestion 4. Insulinoma, with hypersecretion of insulin
38
Q

What is diabetes mellitus?

A

caused by insulin deficiency or insensitivity - leads to hyperglycaemia

39
Q

Describe the 2 types of diabetes?

A
  1. Type1 or insulin dependent DM(IDDM): caused by insulin deficiency 2. Type 2 or non insulin-dependent DM (NIDDM): caused by insulin deficiency and/or resistance
40
Q

Describe type 1 diabetes?

A
  1. Caused by autoimmune destruction of the beta cells and insulin deficiency 2. Common in the young but can occur at any age 3. There is a genetic component of about 30%
41
Q

Describe type 2 diabetes?

A
  1. A disease of the elderly especially obese people 2. Accounts for 90% of diabetes cases worldwide 3. Caused by insulin deficiency, insulin resistance or a combination of both
42
Q

What is the diagnosis of diabetes?

A

Blood glucose levels are normally 3.5 – 5.5 mmol/L after an overnight fast so DM is diagnosed if fasting glucose is above 7.8 mmol/L on two occasions

43
Q

What are the markers that suggest close observation in diagnosing diabetes?

A
  1. glycosuria - glucose in urine 2. Fasting blood glucose of 6 – 7 mmol/L 3. Random blood glucose of >11.1 mmol/L
44
Q

Describe the treatment of diabetes?

A
  1. diet alone (type 2) 2. diet and oral hypoglycaemic agents (type 2) 3. diet and insulin (types 1 and 2) - All patients with Type 1 and many with Type 2 are treated with subcutaneous insulin injections to reduce acute and chronic complications
45
Q

What else is managed alongside diabetes?

A

obesity, hypertension and dyslipidaemia

46
Q

What diet should a person with diabetes observe?

A
  1. Avoid carbohydrates that can be rapidly absorbed (e.g. glucose) to prevent hyperglycaemia 2. Eat regular, small meals to prevent hypoglycaemia 3. Control calorie intake to lose/stabilize weight (especially Type 2) 4. Eat low-fat, healthy diet to reduce atherosclerosis
47
Q

What are oral hypoglycaemic agents for Type 2 Diabetes?

A

oral medication to lower blood glucose

48
Q

Why are subcutaneous insulin injections taken?

A

insulin gets inactivated by digestion if taken orally

49
Q

What do insulin injections treat?

A

all Type 1 patients and some Type 2 patients

50
Q

Why is rembinant human insulin preffered over porcine insuline?

A

it reduces immunological reactions

51
Q

Describe the administration of insulin injections?

A
  1. Long acting insulin is given in the morning and at night 2. Short acting insulin is given 15 min prior to a meal

MBBS 2: Endocrine Physiology (3 decks)

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