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Endocrinology - Kalnins 2017 > Pancreas / Diabetes > Flashcards

Pancreas / Diabetes Flashcards

1
Q

these endocrine cells of the pancreas secrete insulin, glucagon and somatostatin directly into the blood

A

islet of Langerhans

1-2% mass of pancreas

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2
Q

these exocrine cells of the pancrease secrete digestive enzymes into tiny ducts while also possessing some bicarbonate-secreting cells

A

pancreatic acinar cells

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3
Q

what is the largest duct of the pancreas?

A

pancreatic duct

  • joins the common bile duct (LV/GB) to enter the duodenum at the hepatopancreatic ampulla (ampulla of Vater)
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4
Q

what smooth muscle regulates the release of secretions from the pancreatic duct?

A

hepatopancreatic sphincter (sphincter of Oddi)

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5
Q

how much pancreatic juice is produced daily?

A

1200-1500 mL

water, some salt
sodium bicarbonate (alkalinizes pancreatic juice & later chyme 7.1-8.2)
enzymes

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6
Q

what zymogens are contained within the pancreatic secretions?

A
  • pancreatic amylase
  • trypsin, chymotrypsin, carboxypeptidase, elastase
  • pancreatic lipase
  • ribonuclease, deoxyribonuclease
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7
Q

what aspect of the pancreatic secretions stops the action of pepsin in the duodenum?

A

sodium bicarbonate (pH 7.1-8.2)

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8
Q

what 3 things stimulate exocrine secretion from the pancreas?

A
  • PNS (gastric phase of digestion - vagas n.)

Mucus secretes these in response to chyme entering duodenum:

  • Secretin (goes through portal blood to pancreas increasing bicarb)
  • Cholecystokinin (CCK) (enters portal blood to pancreas stimulating digestive enzyme secretion)
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9
Q

these endocrine pancreas cells produce GLUCAGON, active in the liver and kidneys to promote glycogenolysis and gluconeogenesis - making up approx 15-20% of the pancreas - what are they?

A

Alpha cells

secretions
stimulated by: hypoglycemia, epi, ACh, CCK
inhibited by: somatostatin, insulin, PPARgamma

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10
Q

these endocrine pancreas cells produce INSULIN, C-PEPTIDE & AMYLIN, making up 65-80% of the pancreas - which cell type is this?

A

Beta cells

BETA CELLS have GLUT2 TRANSPORTERS*
most other cells have GLUT4

insulin:amylin = 100:1

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11
Q

what are the actions of amylin from the beta cell of the pancreas??

A

slows gastric emptying
promotes satiety
prevents post-prandial spikes in blood glucose

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12
Q

these endocrine cells produce somatostatin which inhibits alpha and beta cells in the pancreas, decreases stomach acid, suppresses other GI hormones, inhibits GH, suppresses exocrine pancreas activity too! It essentially puts the brakes on everything. What cell makes this emergency brake?

A

Delta cells (3-10% of cells)

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13
Q

these endocrine cells produce pancreatic polypeptide - which helps to regulate pancreatic secretions, influence hepatic glygocen levels and GI secretions - what cell type is this?

A

PP cells (3-5%)

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14
Q

these endocrine cells produce ghrelin the hunger hormone! which is secreted when the stomach is empty and acts on the brain to increase hunger.. Which cell type make this one?

A

Epsilon cells (<1%)

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15
Q

this hormone, inhibits secretory activity in the stomach, potentiates secretin, increases enzyme-rich pancreatic juice, stimulates GB contraction and relaxes the sphincter of oddy to allow entry of bile and pancreatic juice into the duodenum

A

Cholecystokinin (CCK)

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16
Q

this hormone inhibits HCl production (minor) but mostly stimulates the release of insulin and therefore is a target for diabetic pharmacologic therapy

A

Gastric Inhibitory Peptide (GIP)

made in duodenal mucosa

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17
Q

this hormone increases HCl secretion, stimulats gastric emptying (minor). It stimulates contraction fthe intestinal muscle, relaxes the ileocecal valve and stimulates mass movements

A

Gastrin

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18
Q

this hormone activates parietal cells to release HCl

A

histamine

stomach mucosa produces this

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19
Q

this hormone stimulates the migrating motor complex

A

Motilin

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20
Q

this hormone causes contraction of stomach muscle

A

serotonin

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21
Q

this hormone inhibits everything - the big brake! all things digestive.. what is it?

A

somatostatin

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22
Q

this peptide hormone regulates metabolism of carbohydrates and lipid by promoting absorption of glucose from the blood to the myocytes and adipose

A

insulin

the hormone of anabolism

  • increased glycogen synth (LV and mm), FA synthesis and storage (adipose), AA uptake
  • decrease -lysis of protein, lipid and glucose
  • decrease autophagy
  • increase HCl in stomach
23
Q

insulin consists of 2 polypeptide chains, A & B, what bond links these chains?

A

disulfide bond

the same bond responsible for curly hair!

24
Q

insulin is first synthesized as a single polypeptide called

A

preproinsulin

this is what exits the ribosome, then signal peptide binds to lead preproinsulin to the rough ER, where it enters and becomes proinsulin

25
Q

Where is proinsulin cleaved by endopeptidases into C-peptide and insulin (A=B chains, disulfide)

A

trans-Golgi network (TGN)

26
Q

what is a better measure of insulin levels?

A

c-peptide

  • insulin and c-peptide are released from pancreas - DM2 pts secrete increased proinsulin, indistinguishable from insulin - c-peptide is therefore a better indicator
27
Q

What are the two phases of insulin release?

A
  • rapid phase in response to dietary glucose

- sustained, slow release independent of glucose (GIP, GLP-1)

28
Q

aside from glucose, the main promoter of insulin - what else stimulates it’s release (4)?

A
  • some AAs - leucine, arginine
  • acetylcholine (vagus n.)
  • cholescystokinin (CCK)
  • gastrointestinal incretins (GLP-1, GIP)
29
Q

insulin can be an effective way to treat what?

A

hyperkalemia

due to it’s ability to drive K back into the cell.

30
Q

what enzyme, found in the liver and kidneys, deactivates insulin?

A

insulin-degrading enzyme

4-6 min halflife
degraded in approx 1 hr post-secretion

31
Q

What are the ssx of hypoglycemia

A 
shakiness, nervous, anxious 
palpitations, tachycardia
sweating, pallor, cold, clammy
DILATED pupils
hunger, borborygmus
N/V, abd. discomfort 
HA
32
Q

what is the MC cause of hypoglycemia?

A

over-dose of insulin or oral hypoglycemics

33
Q

Diabetes mellitus is a general term used to describe all states characterized by what?

A

hyperglycemia

Type 1 - AI mediated, absolute insulin deficiency

Type 2 - env/genetic mediated, insulin resistance

34
Q

what are the components of whipples triad?

A
  • ssx hypoglycemia
  • reverses w/glucose admin
  • plasma glucose < 45 mg/dl

can be used to dx insulinoma, from beta cell secreting XS insulin (PanNET tumor)

35
Q

this is an erythematous blistered rash that swells across areas subject to greater friction and pressure (lower abdomen, butt, perineum, groin) - what is it called?

A

Necrolytic migratory erythemia (70% of cases)

> 1000 pg/ml glucagon from a glucagonoma

could be d/t low EFAs (glucagon converts to glucose)

36
Q

This very rare condition that we likely won’t be tested on - presents similarly to cholera - profound watery diarrhea - what is this rare tumor?

A

VIPoma

vasoactive intestinal peptide

37
Q

what are the effects of insulin resistance on adipose and myocytes?

A

adipose - reduces uptake of lipids, increases hydrolysis of stored TGs (effectively increasing both in plasma)

myocytes - decreases glucose uptake and glycogen storage

38
Q

this skin condition characterized by areas of dark velvety discoloration in body folds and creases - it’s also present in some experiencing insulin resistance - name it

A

acanthosis nigricans

39
Q

what organ is insulin resistance thought to begin in?

A

Liver

40% of insulin is first used in the liver before heading out to the periphery.

40
Q

how do we test for insulin resistance in the clinic?

A

HOMA-IR
homeostatic model assessment

reqs

  • fasting insulin
  • fasting glucose

less invasive than euglycemic clamp

41
Q

What is the gold-standard for measuring insulin resistance, but it’s invasive, rarely used in clinic and mostly a research based model for insulin measurement?

A

Hyperinsulinemic Euglycemic Clamp

reqs
- IV infusion of insulin and glucose
glucose is assessed q5-10mins x2 hours

42
Q

The oral glucose tolerance test is used to test women for gestational diabetes during pregnancy - what are the glucose levels after 2 hours we should be aware of?

A
  • < 140 mg/dl normal
  • 140-197 mg/dl impaired glucose tolerance
  • > 200 diabetes mellitus
43
Q

this nutrient is specific for diabetic patients experiencing neuropathy - what is it?

A

alpha lipoid acid
600-1800 mg oral

essential co-factor in mitochondrial enzs

44
Q

Which lab values are diagnostic for diabetes mellitus?

A

HbA1c > 6.5%
fasting glucose > 126 mg/dl
oral glucose TT > 200 mg/dl
non-fasting glucose > 200 mg/dl

if pre-diabetic (100-126 FBG) - retest q1-2yrs

45
Q

what’s the familial concordance (ie chance of acquiring) for DM1 and DM2 with identical twins?

A

DM1 - 50%

DM2 - 90-100%

46
Q

polydipsia, polyphagia, polyuria, weight loss and diabetic keto-acidosis (rapid breathing, mental disorientation or sudden coma) are ssx of what?

A

DM 1

- an absolute deficiency of insulin

47
Q

what is the FBG level for “impaired fasting glucose”

A

100-126 mg/dl

48
Q

when the pancreas hyper-secretes insulin, what’s this called?

A

hyperinsulinemia

49
Q

what replaces the pancreatic islet cells after they’ve become exhausted and insulin secretion ceases

A

amyloid

50
Q

tests of islet cell antibodies are often positive in this diabetes diagnosis - what is it?

A

LADA - latent onset adult diabetes

any non-obese pt presenting with diabetic symptoms should be tested for these

51
Q

which drugs can induce diabetes?

A 
glucocorticoids 
thyroid hormone
beta agonists
phenytoin
INF-alpha
vacor
nicotinic acid
52
Q

this short-term complication of diabetes (mostly type 1) is spilling of glucose in the urine, which can result in severe dehydration with electrolyte imbalance - what’s this called?

A

glycosuria

53
Q

as cells begin to burn fat, instead of glucose - FFAs are broken down and transported to the liver where they are converted to ketones - when these are produced in XS what is this called?

A

acidosis

  • ketones lower blood pH
54
Q

what 3 situations could promote diabetic coma?

A
  • severe diabetic hypoglycemia (gen dt improper insulin dose)
  • diabetic ketoacidosis
  • hyperosmolar non-ketotic coma (elderly, MC - not enough fluid intake)

Endocrinology - Kalnins 2017 (2 decks)

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