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Patient > Pancreas and insulin > Flashcards

Pancreas and insulin Flashcards

1
Q

what is glycogen?

A

stored reservoir of glucose

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2
Q

TF: the CNS can substitute glucose

A

NO, therefore delivery is critical from the blood

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3
Q

hypoglycaemia?

A

<2.5mmol/L

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4
Q

normoglycemia? fasting value

A

3-5mmol/L

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5
Q

normoglycemia? fed state?

A

7-8mmol/L

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6
Q

hyperglycaemia?

A

> 10mmol/L

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7
Q

What happens when a normal person eats something sugary?

A

transiently hyperglycaemic

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8
Q

homeostasis of hyperglycaemia?

A

rise in blood glucose
insulin release from b-cells
lowers glucose in blood

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9
Q

where does insulin act?

A

liver, muscle, adipocytes, CNS

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10
Q

where does endogenous glucose production occur?

A

liver

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11
Q

what is endogenous glucose production?

A

conversion of glycogen to glucose

or formation from food

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12
Q

homeostasis of hypoglycaemia?

A

fall in blood glucose
glucagon release from a-cells
endogenous glucose production- mainly by liver, muscles and adipocytes

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13
Q

how does pro-insulin become human insulin?

A

23 amino acids are removed from proinsulin.

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14
Q

what are the 23 amino acids removed from proinsulin called?

A

C-peptide

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15
Q

where does the conversion of proinsuilin–> insulin occur?

A

insulin secretion cells

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16
Q

what happens to C-peptide?

A

released along side insulin

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17
Q

what can we use c-peptide for?

A

measuring insulin levels- insulin has a short half life so C-peptide tells us how much has been released

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18
Q

where is insulin located and stored?

A

B-cell secretory granules

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19
Q

what is insulin complexed with? structure?

A

zinc

crystal

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20
Q

half life of insulin?

A

3-5 minutes

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21
Q

where is insulin metabolised?

A

the liver

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22
Q

langerhans compose about ___% of the total pancreas.

A

1

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23
Q

most of what the pancreas does is related to?

A

digestion

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24
Q

δ-cells?

A

release somatostatin

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25
Q

ε-cells

A

release ghrelin

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26
Q

what is ghrelin

A

hunger hormone

27
Q

what do PP-cells in the pancreas release?

A

pancreatic polypeptide

28
Q

what does pancreatic polypeptide effect?

A

digestive system

29
Q

___% of the blood at any one moment is bathing the islets

A

25

30
Q

how are the islets distributed in the pancreas?

A

distributed throughout

31
Q

what nerves are the islets connected to? how?

A

enteric and vagus nerve

neutrally connected

32
Q

pathway 1 of insulin release?

A

glucose uptake by isle B-cells
K channels close, depolarisation
Ca2+ influx due to depolarisation
insulin release by exocytosis

33
Q

pathway 2 of insulin release?

A

release of gut hormones from enteroendocrine cells e.g. GLP-1= rise in blood levels
activation on the GLP-1 receptors on B-cells
cell signalling
insulin release

34
Q

for pathway 1 release of insulin is proportional to?

A

the amount of glucose in the blood

35
Q

how can drugs target pathway 1 of insulin release? e.g.?

A

target K channels closing and depolarisation

insulin secretagogues- blocks K channels and causes insulin release whether or not glucose levels have gone up or not = hypoglycaemia

36
Q

how can drugs target the pathway 2 of insulin release?

A

block receptors on b-cells e.g. GLP-1 receptors

37
Q

explain how insulin lowers blood sugar?

A

insulin binds to receptor on cell.
insulin receptor has endogenous kinase activity- switches kinase activity on when binds
cascade
this cascade switches on glucose transporter in the cell membrane AND adds more receptors to the membrane

38
Q

insulin is also a _____ factor

A

growth factor

39
Q

the endocrine actions insulin actions are considered to be ______

A

anabolic

40
Q

effects of insulin (5)

A 
increases transport into cells 
converts glucose to glycogen in the liver 
decreases glycogen to glucose breakdown 
increases fat stores 
increases protein production
41
Q

hyperglycaemia is ______ induced

A

glucagon

42
Q

TF: fat can be broken down to make glucose precursors?

A

TRUE

43
Q

skeletal muscle influence of glucose homeostasis

A

glucose uptake

glucose utilisation

44
Q

GIT influence on glucose homeostasis

A

glucose uptake

incretin effect

45
Q

what is diabetes mellitus?

A

when pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

46
Q

type I diabets is a disease of the _____ cell.

A

beta

47
Q

type II- beta cells _____ and the alpha cells become _____ active. this causes?

A

fail
more
hyperglycaemia

48
Q

what cells is insulin desensitisation felt by

A

liver, skeletal an adipocytes

49
Q

ways to treat diabetes?

A
  • promote loss through kidneys
  • delay absorption in GIT
  • promote insulin release
  • sentitize to action of endogenous insulin
  • replace islets
50
Q

why dont you want to usually promote loss of glucose through kidneys?

A

as it can cause hyper-osmotic shock

51
Q

non medical causes of hypoglycaemia?

A

inadequate, irregular food intake
insulin overdose
sulphonylurea overdose

52
Q

medical causes of hypoglycaemia?

A

insulinoma, hyperinsulinsm, post gastric bypass surgery if morbidly obese

53
Q

autonomic symptoms of hypoglycaemia?

A

hunger, sweating, shaking, increased HR, headache, nausea

54
Q

neuroglycopaenic symptoms of hypoglycaemia?

A

confusion, drowsiness, odd behaviour

55
Q

what is the first aid treatment for severe hypoglycaemia when oral glucose is not possible or desired?

A

glucagon therapy to induce hyperglycaemia

56
Q

what is the route for glucagon therapy?

A

i.v.
s.c.
i.m.
must be reconstituted before use

57
Q

what is the effect of glucagon therapy?

A

acutely raises plasma glucose levels

58
Q

side effects of glucagon therapy?

A

headache

nausea

59
Q

what patients are hyperglycaemia inducing therapies used in?

A

hyperinsulinism or insulinomas

60
Q

what’s diazoxide therapy?

A

hyperglycaemia inducing therapies
reverses the effect of glucose on beta cells
causes hyperpolariation not depolarisation
stops Ca2+ influx and hence insulin release

61
Q

how is diazoxide therapy administered?

A

oral administration

62
Q

side effects of diazoxide therapy?

A 
anorexia 
nausea
vomiting 
hypotension 
oedema 
tachycardia 
arrhythmias
63
Q

what can prolonged diazoxide therapy cause?

A

hypertrichosis- excessive hair growth all over the body

Patient (19 decks)

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