Sesh 10- Endocrine Pancreas and Diabetes Mellitus Flashcards

1
Q

What are the cells that perform the endocrine function of the pancreas called?

A

Islets of Langerhans

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2
Q

What are the 3 main peptide hormones made by the pancreas?

A

Insulin
Glucagon
Somatostatin

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3
Q

Which specific cell types within the Islets of Langerhans are insulin and glucagon secreted by?

A

Insulin- beta cells

Glucagon- alpha cells

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4
Q

What are the 2 main actions of glucagon on the liver?

A
  • Glycogenolysis

- Gluconeogenesis

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5
Q

Are insulins actions anabolic or catabolic?

A

Anabolic

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6
Q

What is the renal threshold for glucose reabsorption?

A

10 mmol/L

Is less than this in pregnancy, and increased in the elderly

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7
Q

How is insulin made?

A

As preproinsulin- cleaved in ER to proinsulin

-Cleaved further in golgi–> Insulin + C peptide= stored separately in vesicles

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8
Q

What receptors in pancreatic beta cells allow sensing of plasma glucose?

A

GLUT2

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9
Q

Which channels in pancreatic beta cells shut, causing membrane depolarisation and insulin secretion?

A

K-ATP channels- inhibited by ATP (increases when intracellular glucose increases)

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10
Q

What type of receptor is the insulin receptor?

A

Tyrosine Kinase Receptor

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11
Q

How does insulin increase glucose uptake into cells?

A

Binds cell surface insulin receptor to cause GLUT4 translocation

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12
Q

What are the 4 main broad actions of insulin?

A
  1. Increases intracellular glucose uptake
  2. Increases glycogenesis in liver
  3. Increases protein synthesis
  4. Increases TG storage
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13
Q

On what organ does glucagon mainly have its effects?

A

Liver

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14
Q

What stimulus increases BOTH insulin and glucagon secretion?

A

Increase in amino acids

NB: Insulin increases protein synthesis and glucagon increases a.a. metabolism

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15
Q

Symptoms of hypoglycaemia are similar to being in what state?

A

Drunk

e.g. slurred speech, staggering, loss of consciousness

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16
Q

Diabetes Mellitus is a disease mainly affecting what, and why?

A

Blood vessels, as high blood glucose is toxic to blood vessel endothelium

17
Q

What are 3 main sign/ symptoms of Diabetes Mellitus?

A
  1. Glucosuria
  2. Polydipsia
  3. Polyuria
18
Q

What random plasma glucose concentration would help diagnose Diabetes Mellitus?

A

> 11.1 mM

19
Q

What fasting blood glucose level would support a diagnosis of Diabetes Mellitus?

A

> 7 mmol/L

20
Q

What is type 1 DM caused by?

A

Autoimmune destruction of beta cells or abnormal secretory response of beta cells

21
Q

What is the underlying problem in type 2 DM?

A

Peripheral insulin resistance

22
Q

What is metabolic syndrome?

A

A collection of the most dangerous risk factors assoc w CVD e.g. low HDL, high bp…

23
Q

What are the 2 most important aetiological factors in metabolic syndrome?

A
  • Insulin resistance

- Central obesity

24
Q

What is HbA1c, and how can it be used in diagnosing DM?

A

=glycated Hb

  • If >10%, indicates DM
  • Don’t have to be fasted for the test
25
Q

Why may patients with Type 1 DM have a sweet/acetone smelling breath?

A

May be breaking down fats (lipolysis), leading to a ketoacidosis…ketones are volatile.

26
Q

What would usually be the difference in weight between patients presenting with type 1 or 2 diabetes?

A

Type 1- weight loss

Type 2- central obesity

27
Q

What would be detectable in the blood of a type 2 diabetic, but not a type 1?

A

C-peptide- a marker of endogenous insulin release

28
Q

How does Metformin help in the initial treatment of Type 2 DM?

A

Inhibits gluconeogenesis

29
Q

List the 3 main non-insulin based pharmacological therapies for type 2 DM?

A
  1. Biguanides- Metformin
  2. Sulphonylureas
  3. SGLT2s
30
Q

What are 3 main microvascular complications with DM?

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy (diabetic foot)
31
Q

What are 3 main macrovascular complications with DM?

A
  1. Cerebrovascular disease- Stroke
  2. Peripheral vascular disease
  3. CVD- MI