*Physiology 4 (lecture 6)

Question 1

Why is the feedback control of plasma glucose so critical?

Answer 1

The brain is a “glucose obligate” tissue and stores little glycogen
The blood brain barrier makes the brain inaccessible to plasma fatty acids

Question 2

When does hypoglycaemia occur?

Answer 2

When blood sugar levels fall below 4 mmol/L (if below 2.5 can cause confusion and coma)

Question 3

What effect does chronic hyperglycaemia have on blood vessels?

Answer 3

Damages them

Question 4

What hormones control [glucose]p in the absorptive and post-absorptive state (fed and between meals)? (2)

Answer 4

Insulin and glucagon (pancreas)

Question 5

What hormones control [glucose]p in emergencies?

Answer 5

Glucagon (pancreas)

Question 6

What hormones control [glucose]p during starvation? (2)

Answer 6

Cortisol (adrenal)
Growth hormones (pituitary)

Question 7

What type of cells make up the pancreatic islets of langerhans and what does each secrete?

Answer 7

A cells - glucagon
B cells - insulin
D cells - somatostatin

Question 8

What ensues if the islets of langerhans are removed or destroyed?

Answer 8

Diabetes mellitus - lack of insulin or impaired cellular responses to insulin

Question 9

Changes in glucose, insulin and glucagon levels during the absorptive state?

Answer 9

[Glucose]p rises
[insulin]p rises
[glucagon]p falls

Question 10

What type of meal causes an increase in the amount of insulin released compared to there types of meals?

Answer 10

Carbohydrate rich meals

Question 11

What does insulin do?

Is insulin the hormone of the fed or hungry state?

Answer 11

Favours anabolism
Therefore stimulates conversion of glucose into glycogen, fatty acids into triglycerides and amino acids into protein
Fed-state

Question 12

What does glucagon do?

Is glucagon the hormones of the fed or hungry state?

Answer 12

Favours catabolism
Stimulates conversion of glycogen into glucose and triglycerides into fatty cards
Hungry-state

Question 13

How does insulin lower the plasma concentration of glucose? (2)

Answer 13

By stimulating the uptake of glucose from the blood into fat and muscle cells
Activating the enzyme in the liver and muscle which converts glucose into glycogen
(insulin also promotes the incorporation of amino acids into protein in muscle and promotes lipogenesis in adipose tissue)

Question 14

How does insulin promote glucose uptake into muscle and fat?

Answer 14

insulin causes glucose transporter proteins (GLUT4) to be inserted into the plasma membrane of muscle and dat cells from intracellular stores (when insulin levels drop off the transporters become internalised again)

Question 15

What promotes the secretion of insulin? (5)

Answer 15

Increased glucose
Increased amino acids
increased parasympathetic activity
Increased glucagon (causes it to be produced and stored ready for release, not release)
GIP (glucose-dependent insulinotropic peptide - hormone produced in small intestine)

Question 16

What 2 factors inhibit insulin secretion?

Answer 16

Decreased glucose concentration

Increased sympathetic activity (e.g. exercise or stress)

Question 17

How is diabetes mellitus detected?

Answer 17

Oral glucose tolerance test - patient fasts overnight and is given an oral glucose load, glucose levels measured at regular intervals
If diabetes, fasting glucose level is higher and glucose concentration is high after oral dose)

Question 18

Why are patients with diabetes excessively thirsty?

Answer 18

Glucose appears in urine (as can’t all be converted) causing an increased urinary volume due to osmotic effects, leading to dehydration and consequently thirst

Question 19

Why do patients with diabetes form ketone bodies?

Answer 19

Inability of cells to utilise glucose causes a compensatory increase in lipolysis to generate fatty acids as an energy source
Metabolism of fatty acids generates acetly CoA
Liver unable to process extra acetyl CoA through citric acid cycle = ketone bodies formed
These lower blood pH (metabolic acidosis) initiating compensatory hyperventilation (acid drop breath)

Question 20

Difference between type 1 and type 2 diabetes?

Answer 20

Type 1 diabetes has a childhood onset and is caused by little or no insulin secretion due to a defect in B-cell function, if untreated ketosis develops and it is treated with insulin injections (develops rapidly)
Type 2 diabetes is usually an adult onset and insulin secretion mat be normal (or exceed normal), caused by defect in insulin sensitivity, ketosis rare, diet/ exercise and oral drugs for treatment (Symptoms develop slowly)

Question 21

What stimulates glucagon release?

Answer 21

Decreased blood glucose levels (direct effect on alpha-cells)
Amino acids (raises plasma glucose concentration after protein meal)
Sympathetic nerve activity

Question 22

What inhibits glucagon release? (2)

Answer 22

Raised blood glucose

Insulin

Question 23

How does glucagon raise [glucose]p?

Answer 23

Increased liver glycogenolysis
Inhibiting liver glycogen synthesis
Promoting liver gluconeogensis
Also promotes lipolysis in liver and adipose tissue

Question 24

How long is the store of glycogen in the liver and muscle sufficient to provide glucose for in the typical adult?

Answer 24

Approx. 8 hours

Question 25

What if we go without food for longer than our supply of glucose is?

Answer 25

Fats are metabolised
Protein is catabolised - serious consequences such as muscle wasting
Aim is to ensure brain and heart maintain energy supply

Question 26

What 2 hormones raise blood glucose levels in response to stress?

Answer 26

Adrenaline and cortisol

Question 27

Where is growth hormone released?

Answer 27

From anterior lobe of pituitary

Question 28

What does growth hormone do during starvation?

Answer 28

Decreases glucose uptake by muscle - “glucose sparing” action
Mobilised glucose from liver
Also promotes lipolysis