Pancreas and Diabetes

Question 1

Which two hormones does the pancreas secrete ?

Answer 1

Insulin and glucagon

Question 2

Islet of Langerhans has three cell types, what are they?

Answer 2

1. Alpha cells
2. Beta cells
3. Delta cells

Question 3

What do Alpha cells secrete?

Answer 3

Glucagon

Question 4

What do Beta cells secrete?

Answer 4

Insulin

Question 5

What do Delta cells secrete?

Answer 5

Somatostatin and pancreatic polypeptide

Question 6

What 4 things does insulin cause the body to do?

Answer 6

1. Carbs to be stored as glycogen in muscle/liver
2. Causes fat storage in adipose tissue
3. Excess carbs that aren’t converted to glyogen are converted to fat and stored
4. Promotes uptake of amino acids and conversion to protein

Question 7

Insulin secretion is secreted by what?

Answer 7

1. High blood glucose
2. Amino acids
3. Beta-keto acids
4. Acetylcholine
5. Glyburide
6. Obesity

Question 8

Insulin secretion is inhibited by what?

Answer 8

1. Low blood glucose
2. Fasting
3. Catecholamines
4. Somatostatin

Question 9

Describe the metabolism of insulin?

Answer 9

Plasma half life is 6 mins.

Insulinase degrades unused insulin in live, kidney, and muscles

Question 10

Which cells in the body handle glucose differently than any other cell group?

Answer 10

Neurons in the brain are permeable to glucose

Question 11

Is insulin an anabolic or catabolic molecule?

Answer 11

Anabolic

Question 12

How do glycogenesis and glyconeogenesis differ?

Answer 12

Glycogenesis is storing glucose as glycogen

Glyconeogensis is formation of glycogen from non-carbohydrate sources

Question 13

What is glucagon?

Answer 13

Secreted by alpha cells when blood glucose levels fall. It opposes the effects of insulin.

Question 14

Insulin or Glucagon: Increases gluconeogenesis?

Answer 14

Glucagon

Question 15

Insulin or Glucagon: Increases glucogenesis?

Answer 15

Insulin

Question 16

Insulin or Glucagon: Inhibits gluconeogenesis and glucogenolysis?

Answer 16

Insulin

Question 17

Glucagon is stimulated by what?

Answer 17

1. Fasting hypoglycemia
2. Amino acids
3. Beta-adrenergic stimulation
4. Exercise
5. Cholecystokinin, gastrin, and cortisol

Question 18

What inhibits glucagon secretion?

Answer 18

1. High glucose levels
2. Somatostatin
3. Free fatty acids
4. Ketones
5. Insulin

Question 19

Anabolic or Catabolic: Associated with the postprandial phase?

Answer 19

Anabolic

Question 20

Describe the anabolic phase?

Answer 20

1. Eat a meal
2. blood glucose rises above 100
3. Insulin level increases 10 fold
4. Level decreases 5-10 later
5. Shut off 3-5 after glucose level under 80

Question 21

12-24 hours of fasting, what does the body produce energy from?

Answer 21

Liver glycogen sufficient for brain

Question 22

After 24 hrs, what does the body produce energy from?

Answer 22

Gluconeogenesis uses AAs, glycerol, and lactate

Question 23

What is the most common endocrinopathy?

Answer 23

Diabetes Mellitus

Question 24

How do Type 1 and 2 DM differ?

Answer 24

Type 1= Causes by lack of insulin secretion

Type 2= Caused by decreased sensitivity of tissues to the metabolic effects of insulin

Question 25

Glucose being reabsorbed by the kidney results in what?

Answer 25

1. Osmotic diuresis, loss of Na, K, and glucosuria | 2. Hypovolemic hypotension, dehydration, polyuria, polydipsia, polyphagia

Question 26

What are 5 acute symptoms of DM?

Answer 26

1. Polyuria 2. Polydipsia 3. Polyphagia 4. CNS irritability/confusion 5. Visual disturbances

Question 27

What are the 3 chronic symptoms of DM?

Answer 27

1. Infection 2. Macrovascular disease 3. Microvascular disease

Question 28

What is the leading cause of blindness in the US ages 20-65?

Answer 28

Retinopathy related to DM

Question 29

What percentage of pt with DM develop chronic renal failure?

Answer 29

50%

Question 30

DM 1 or DM 2 characterized by destruction of Beta Cells and loss of insulin release?

Answer 30

DM 1

Question 31

What is normal A1C?

Answer 31

4%-5.6%

Question 32

Hgb A1C of 7.5 represents what average blood sugar level?

Answer 32

187

Question 33

Perioperative hyperglycemia causes increased what?

Answer 33

1. CHF 2. 18x higher mortality 3. 2 x longer stay 4. Infection risk 5. Sepsis 6. ARF 7. Neuropathies 8. CVA 9. Poor fetal outcomes

Question 34

What is general consensus on ideal blood glucose perioperatively?

Answer 34

>200 should be treated

Question 35

Guidelines for periop management of DM?

Answer 35

1. Plan as 1st surgery 2. Hold oral hypoglycemics day of 3. Insulin should be 1/2 dose 4. Type 1 DM should cont insulin pump

Question 36

What will insulinoma result in?

Answer 36

Beta cell adenoma results in insulin shock and coma under 20mg/dl Treat with glucose, glucagon and epinephrine