Physiology Flashcards
Where is insulin synthesised?
beta cells in the pancreatic islet
what is the role of insulin?
lowers the plasma glucose level
what stimulates the release of insulin?
high plasma glucose level
where is glucagon synthesied?
alpha cells in the pancreatic islet
what is the role of glucagon?
raises the plasma glucose level
what stimulates the release of glucagon?
low plasma glucose level
what is proinsulin?
molecule which is the form insulin takes up inside the beta cell before being released
in this molecule insulin is cleaved to c peptide
why is c-peptide a useful way to measure endogenous insulin secretion?
ii. why may it not be useful?
It is co-secreted with insulin but not part of injected insulin. Therefore if c-peptide is present in the blood it must be coming from the person’s beta cells
Useful in diagnosing patients for Type 1 (should be after 3 years of diagnosis)
ii.The test may be less helpful close to diagnosis, particularly where a patient is overweight and insulin resistant, as levels close to diagnosis in Type 1 diabetes may be high and overlap with those seen in type 2 diabetes
What is HbA1c and why is it useful in measuring glucose levels?
It is glycated haemoglobin
it forms when haemoglobin is exposed to glucose and become glycated
amount of glycation is proportional to the glucose level
why is HbA1c not useful when patients have anaemia?
RBCs normally live for 120 days and HbA1c gives a reasonable understanding of the patients glucose level for the past 3 months
Anaemia reduces the RBC turnover therefore will give a low HBA1c result which may be misleading
what is the HbA1c value which signifies the patient has diabetes?
48 mmol/mole or 6.5%
remember that each 1% increase there is an 11 mmol/mole increase
what are the the different endocrine cell types found in the islets of langerhans?
alpha cells
beta cells
delta cells
Pancreatic polypeptide cells (PP)
Epsilon cells (ε-cells)
what is the role of delta cells?
secretes somatostatin
what is the role of pancreatic polypeptide cells?
secretes pancreatic polypeptide
what is the role of Epsilon cells (ε-cells)?
Ghrelin
what happens to the normoglycaemia if a person fasts/exercise?
- lowers - can become hypoglycaemic (hypolipidaemia too)
- Glucagon is triggered and insulin is inhibited
- glucose is produced (Lipolysis)
n. b. adrenaline can be used to increase glucose production in its own pathway
what happens to the normoglycaemia if a person eats?
- raise blood glucose - can become hyperglycaemic (hyperlipidaemia too)
- Insulin is triggered and glucagon is inhibited (lipid storage)
- glycogen synthesis
what else apart from glucose do Beta cells respond to?
- Amino acids
- fatty acids
- IL6
- Leptin
- Glucagon
- GLP1
- GIP
- Acetylcholine
- Igf1
How does a beta cell release insulin?
in a biphasmic manner
1st phase is very important as it releases insulin within 2 minutes of glucose secretion.
it is the first sign that a patient has beta cell disfunction due to lack of response
Give example of essential molecular components in beta cells for glucose sensing.
- Glucose transporters (GLUT1/2)
- Glucokinase (GCK)
- oxidative metabolism
- k ATP-channels
- L type voltage dependant channels
- Exocytotic machinery
what happens in alpha cells when there is low glucose?
- Glucose uptake and metabolism low.
- katp channels open
- Voltage-gated sodium channels contribute to action potentials
- P/q type voltage gated calcium channels enable calcium influx
- Glucagon exocytosis triggered
what happens in alpha cells when there is high glucose?
- Glucose uptake and metabolism high
- katp channels closed, cell depolarised
- Presence of SGLT2 glucose transporters contributes to non-voltage-regulated sodium ion influx
- NAV and CAv channels closed and Glucagon not released
Give examples of islet defects in type 2 diabetes?
- impaired insulin secretion
- dyregulated glucagon secretion:
i. lack of suppression of GCG secretion at high glucose
ii. May contribute to hyperglycaemia
when is somatostatin 14 released?
it is a paracrine regulator in response to nutrient or hormonal stimulation
it suppresses beta cell and alpha cell function
what is paracrine signalling?
like endocrine release of hormones which travel through the blood stream to a target tissue but travels much shorter distance
what is the principle incretin hormone?
Glucagon Like peptide 1 (GLP1)
what is GLP1 released due to?
glucose
amino acids
fatty acids
which cells release GLP1?
L-cells - it is released biphasic manner
what is the role of GLP1?
- potentiates insulin secretion from pancreatic beta cells
- reduces apetite
- inhibits glucagon secretion
- delay gastric emptying
where are L cells found?
Ileum and colon
which gene is responsible for coding for GLP1?
glucagon
then creates pre protein Pro glucagon
then pro horomone convertase (PC1/3) makes GLP1
GLP1 has a very short half life true or false?
ii. what could be used instead for incretin treatment for T2 diabetes?
true- difficult therefore to give as a therapeutic due degradation by DPPIV
ii. however GLP1 analogue is useful which has an increased stability in serum or DPPIV inhibitors
what is the effect of bariatric surgery on incretin?
increased GLP1 response as nutrients reach L cells more quickly
what type of hormone is insulin?
anabolic
protein/peptide
how many molecules of ATP are produced after oxidative phosphorylation of one glucose molecule?
36
what type of target cells are involved in endocrine signalling?
distant target cell
what type of target cells are involved in autocrine signalling?
acting on itself
what type of target cells are involved in paracrine signalling?
surrounding (local) cells
what are the 3 main classes of hormones?
- (glyco)proteins and peptides
- steroids
- tyrosine and tryptophan derivatives
what molecule are steroids derived from?
cholesterol
what type of hormone is oxytocin?
protein/peptide
what type of hormone is cortisol?
steroid
what type of hormone is aldosterone?
steroid
what type of hormone is adrenaline or epinephrine?
tyrosine/tryptophan derivatives
what type of hormones are the thyroid hormones?
tyrosine derivatives
what type of hormone is testosterone?
steroid
are amines pre-synthesised and stored or synthesised on demand?
pre-synthesised and stored
where are amines stored?
intracellular vesicles
Name all the glands and organs which make up the endocrine system.
- Pineal gland
- Pituitary gland
- thyroid gland
- Parathyroid glands
- Thymus
- adrenal glands
- Pancreas
- Ovaries
- Testes
what does the thyroid gland tissue secrete?
Thyroxine (t4)
Tri-iodothyronine (T3)
Calcitonin
what do parathyroid glands secrete?
Parathyroid hormone (PTH)
what is the basic functional unit of the thyroid gland?
Follicle
what does the follicle consist of?
Follicular cells enclose a colloid.
Parafollicular cells located adjacent to the thyroid follicles and reside in the connective tissue. These cells are large and have a pale stain compared with the follicular cells.