L38 - Physiology of insulin&glucagon Flashcards

1
Q

Pancreas blood supply?

A

Head = SMA + Pancreaticoduodenal artery

Neck, Body and Tail = Splenic artery

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2
Q

Define the 2 functional components of pancreas?

A

1) Exocrine = acinar cells secrete digestive enzymes into duodenum
2) Endocrine = islets of Langerhans for glucose homeostasis

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3
Q

Define the cell types in the islets of Langerhans in pancrease and their secretion?

A

Alpha(α) cells:

  • 30-45% total islet cells
  • Glucagon

Beta (β) cells

  • 45-60%
  • Insulin

Delta (δ)cells

  • 3- 10%
  • Somatostatin
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4
Q

Describe the feedback regulation of pancreatic hormone secretion?

A

Insulin activate B-cells + inhibit a-cells

Glucagon activate a-cells&raquo_space; activate beta and delta cells too

Somatostatin inhibit alpha and beta cells

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5
Q

Precursors of insulin? Structure of mature insulin?

A

Preproinsulin: Signal peptide + A and B chains joined by C chain

Proinsulin = A and B chain joined by double SS bond, removed signal peptide

Mature Insulin = A and B chain only, removed C chain

Joined by 2 pairs of disulfide bonds + one intramolecular disulfide bond in A chain

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6
Q

Which peptide is measured to indicate normal synthesis of endogenous insulin?

A

C peptide

Equimolar amounts of C-peptide and insulin are stored in secretory granules in pancreatic Beta cells

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7
Q

Describe the mechanism of insulin release from B cells?

A

Unstimualted: ATP-sensitive K channel open, maintain resting membrane potential

High extracellular glucose
» Glucose diffuse through membrane transporter
» ATP production by TCA cycle and glycolysis
» Closure of ATP-sensitive K channels
» No K efflux, Depolarization opens V-gated Ca channels
» Increase cytosolic Ca concentration, Insulin granule exocytosis

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8
Q

Structure of insulin receptor?

A

2 Tyrosine kinase receptor:
α- subunit for ligand binding
β- subunit for protein kinase

Linked by disulfide bonds into a Tetramer (functionally dimeric protein complex)

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9
Q

Describe the activation of insulin receptor?

A

Insulin bind to a-subunit
» activate tyrosine kinase
» cause cross phosphorylation of B-subunit
» phosphorylation of insulin receptor substrate 1 (IRS-1)
» act as docking center for other downstream enzymes

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10
Q

Define the 2 intracellular pathways triggered by insulin receptor activation?

A

PI3K/AKT pathway = control metabolic effects: Antilipolysis, glucose uptake, glycogen and protein synthesis

Ras/ERK pathway = control cell growth and differentiation

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11
Q

Summarize the effects of insulin on peripheral tissue?

A

Muscle and adipose tissue:

  • Increase insertion of GLUT-4 onto membrane = increase glu. intake
  • Inhibit lipolysis

Muscle and liver:
- Stimulate glycogenesis by Glycogen synthase

Liver:

  • Inhibit gluconeogenesis and glycogenolysis
  • Increase Lipogenesis
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12
Q

Describe how the liver and adipocytes work together to process high plasma glucose?

A

Increase glycogenesis in liver first

> > if glucose level still too high
convert G 6-P to Fatty acid and transfer to adipocyte
Glucose at adipocyte form glycerol, combine with FA from liver
form Triglycerides

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13
Q

Structure and precursors of glucagon?

A

29 a.a.

Proglucagon&raquo_space; proteolysis process&raquo_space; mature glucagon

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14
Q

Describe the mechanism of glucagon secretion at low glucose level?

A

Low glucose level: self-fire:

  • ATP-sensitive K channel remain open
  • T-type Ca channel open&raquo_space; depolarization trigger Na+ channel activation
  • AP triggered&raquo_space; Ca entry through N-type channels
  • Induce glucagon granule exocytosis
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15
Q

Describe the mechanism of glucagon secretion at high glucose levels?

A
  • Glucose enters a-cells and metabolized to ATP
  • ATP causes ATP-sensitive K channel to close
  • Inactivation of T-type Ca channels and Na channel
  • No glucagon granule exocytosis

** Insulin blocks all channels: T-type Ca channel, Na channel and ATP-sensitive K channel **

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16
Q

Paracrine and intrinsic regulation of glucagon are mutually exclusive. T or F?

A

False

Isolated a-cells cannot respond properly without insulin effects

17
Q

Summarize physiological effects of glucagon?

A

1) Liver: Activate cAMP/PKA pathway:
- Inactivate glycogen synthase > less glycogenesis
- Activate glycogen phosphorylase > glycogenolysis
- induces the expression of gluconeogenic genes&raquo_space; gluconeogenesis

2) Adipose tissue: cAMP/PKA pathway:
- activates hormone- sensitive lipase (HSL)
» mobilize stored fats and stimulates lipolysis&raquo_space; FA to liver for gluconeogenesis

18
Q

What type of receptor is glucagon receptor?

A

GPCR

19
Q

3 types of Diabetes mellitus?

A

Type 1 (Juvenile diabetes/ Insulin-dependent DM)

Type 2 (Non-insulin dependent DM = NIDDM)

Gestational diabetes

20
Q

Cause of Type 1 DM?

A

Autoimmune destruction of B cells, inability to synthesize insulin

21
Q

Cause of Type 2 DM?

A

Target tissue fail to respond to insulin due to defects in insulin signalling or Lipid-induced insulin resistance (overnutrition)

22
Q

Mechanism of lipid-induced insulin resistance?

A

Obesity
> excessive fat in muscle, liver intracellular lipid
> converted to DAG to trigger PKC pathways
> Phosphorylate IRS-1 at serine residues
> Defect insulin signalling

23
Q

Pathogenesis of gestational diabetes?

A
  • Excessive glucose to fetus cause increased lipogenesis = obesity
  • Fetal liver produces excess insulin = hypoglycemia after birth
24
Q

List some causes of non-type 1 or 2 diabetes?

A

Acromegaly (excess grwoth hormone)

Cushing syndrome (excess cortisol)

Thyroitoxicosis (excess thyroid hormone - increase glucose absorption in gut)

Pheochromocytoma (increase Adrenaline/ NE)

Glucagonoma

25
Q

List some symptoms of DM?

A
  • Polyuria
  • Unexplained weight loss
  • Increased appetite, thirst (polydipsia)
  • Fatigue
  • Blurred vision, retinopathy
  • Diabetic neuropathy
  • Diabetic ketoacidosis
26
Q

Explain how DM causes polyuria?

A

Increase glucose in glomerular filtrate = filtrate becomes hypo-osmolar (too much free water)

> decrease water reabsorption, increase urine volume

27
Q

Explain how DM causes unexplained weight loss and increase appetite??

A

Cannot intake and utilize glucose after meal&raquo_space; increase lipolysis and proteolysis for gluconeogenesis&raquo_space; weight loss

Fail to utilize glucose&raquo_space; increase appetite

28
Q

Mechanism of diabetes- caused cataracts?

A

Glucose converted to Sorbitol in lens (by Aldose reductase)

Sorbitol not converted to fructose (lack of sorbitol dehydrogenase in lens)

Excess Sorbitol cause osmotic damage: increased fluid influx, depletion of NADPH

29
Q

Symptoms and causes of insulin excess?

A

 Insulinoma
 Accidental / deliberate injection of excessive insulin

 Hypoglycaemia =CNS effects: sedation, drowsiness, confusion
 Autonomic discharge: palpitation, sweating, nervousness

30
Q

Describe how DM leads to diabetic ketoacidosis?

A

Reduced glucose uptake into cells

> > Trigger glucogenesis and gluconeogenesis

> Increase fat breakdown causing high ketone levels

> > impair brain function, coma and death

31
Q

List 5 hormones that increase the plasma glucose level?

A

Cortisol, growth hormone, catecholamines (adrenaline, noradrenaline), thyroid hormones, glucagon

32
Q

Describe how DM can lead to hyperglycaemic coma?

A

Uncontrolled extracellular hyperglycaemia

> > severely hyperosmotic plasma with high solute concentration

> > Movement of water from cells into interstitium

> > Dehydration of brain cells and neurons

33
Q

List some vascular complications of DM?

A

Atherosclerosis, Coronary artery disease, Stroke, Nephropathy, neuropathy, retinopathy