Lecture #4 -- Endocrine Pancreas Physiology Flashcards Preview

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Flashcards in Lecture #4 -- Endocrine Pancreas Physiology Deck (66):
1

Where is blood sugar normally?
Right after a meal?

Fasting State -- 70-100 mg/dL
Post prandial state -- usually under 140 mg/dL

2

Common symptoms of low blood glucose

Sweating, Nervousness, Tachycardia, Dizziness

3

Common symptoms of high blood sugar

Polyuria, Polydipsia, Blurred Vision

4

Alpha cells produce...

Glucagon

5

Beta cells produce....

Insulin and Amylin

6

Delta cells produce

Somatostatin

7

Epsilon cells produce...

Ghrelin

8

F cells produce

pancreatic polypeptide

9

Use of C-peptide measurement?

Measuring C peptide give you an idea how how much insulin is being generated endogenously (rather than injected)

10

Describe the structure of insulin

Two chains derived from proinsulin
Joined by two disulfide bonds

11

Describe the process of Insulin secretion

Glucose in through Glut2
Insulin used to make ATP
ATP closes K channel, Depolarization
Depolarization lets Ca in, allows exocytosis

12

Primary 5 effects of insulin

Promotes glucose/AA uptake and storage in target cells
Promotes Glycogen formation in Liver and Muscle
Inhibits gluconeogenesis
Stimulates lipid synthesis
Stimulates K uptake by cells

13

Two ways insulin promotes the formation of glycogen.

Stimulates glycogen synthase
Inhibits glycogen phosphorylase

14

Insulin receptos has _____ ____ ______ activity

Intrinsic Tyrosine Kinase

15

Insulin inhibits ______ to inhibit gluconeogenesis

phospholenolpyruvate corboxykinase

16

Insulin activates _____ to convert glucose to glycogen

Glycogen Synthetase

17

Other than glucose, four factors that regulate glucose

Amino Acids
Keto Acids
Epinephrine
Glucagon

18

Amino acid affect on insulin release?

Stimulate it

19

Ketoacid affect on insulin release?

Stimulate it
Increase glu uptake to prevent lipid and protein utilization

20

Epinephrine affect on insulin release?

Adrenal epinephrine inhibits insulin to maintain blood Glu levels

21

Glucagon affect on insulin release?

Stimulates secretion

22

Whats the incretin effect all about?

Glucose taken in orally will generate a much greater insulin response than insulin that is provided via IV. When digested, glucose is accompanied by costimulatory molecules that allow for heightened INS secretion.

23

Effect of Insulin on Glucose level?

Decreases it

24

Effect of Insulin on Fatty Acid level?

Decreases it

25

Effect of Insulin on Ketoacid level?

Decreases it

26

Effect of Insulin on Amino Acid levels?

Decreases it

27

Main target tissues of glucagon?

Liver, Muscle, and Adipose Tissue

28

How does glucagon work?

Binds to a Gs receptor, inc. cAMP, inc. PKA
Activates IP3 (inc. Ca)

29

Primary actions of Glucagon

Increases Glycogenolysis
Increases Gluconeogenesis
Increases Lipolysis
Increases Ketoacid formation

30

Effect of Glucagon on Glucose blood level?

Increased

31

Effect of Glucagon on FA blood level?

Increased

32

Effect of Glucagon on Ketoacid blood level?

Increased

33

Normal Insulin/glucagon ratio

2:1

34

What happens to Ins/Glu ratio in prolonged exercise?

Ratio drops to 0.5:1
Want to maintain glucose to the brain

35

Gluconeogenesis in the liver also leads to production of what metabolic product?

Urea

36

Following a meal, what changes should you see in glucose, insulin, and glucagon levels

Increased Glucose and Insulin
Decreased Glucagon

37

Glucagon excess and insulin deficiency have ________ effects

Additive

38

Four regulators of glucagon release

Glucose
AA
Stress
Insulin

39

Influence of glucose on glucagon release?

Inhibits it

40

Influence of amino acids on glucagon release?

Stimulates It

41

Influence of stress on glucagon release?

Epinephrine --> beta adrenergic receptors on alpha cells
Increased glucagon release

42

Influence of insulin on glucagon secretion

Inhibits it

43

What is Necrolytic Migratory Erythema (glucagonoma syndrome)

Tumor of the Islet Cells
Erythematous, Scaly plaques, hyperglycemia, diarrhea, weight loss, and atrophic glossitis

44

Other that insulin and glucagon....what are three additional factors that regulate glucose homeostasis

Catecholemines (inc. glycogenolysis+lipolysis)
Growth Hormone (inc. glycogenolysis+lipolysis)
Glucocorticoids (inc. gluconeogenesis, proteolysis, and lipolysis)

45

Cortisol, GH, and GH move with what hormone?

Glucagon

46

Symptoms of Diabetes Mellitus

Frequent Urination
Thirst
Increased Food Consumption
Weight Loss

47

Four types of diabetes mellitus

Type I, Type II, pre-diabetes, Gestational diabetes

48

What happens in Type I diabetes?

Killer T cells target glutamate decarboxylase in the beta cells, killing the cells
Glu can't get into adipose, inc. blood glucagon

49

Type I diabetes is a Type ____ hypersensitivity reaction

4

50

Type I is associated with what receptor?

HLA DR3-4

51

Symptoms of an untreated Type I diabetic

Inc. glucose
Weight low, low muscle mass, polyphagia
Polyuria, polydipsia, glycosuria

52

How is Type 1 treated?

Lifelong Insulin

53

What is diabetic ketoacidosis?

Serum ketoacids in blood
Caused by stress, infection, not taking insulin

54

Why does high glucagon lead to ketoacidosis?

Glu --Lipolysis--> FFAs --liver conversion--> ketones

55

Blood values expected in a DKA patient?

Hyperglycemia (over 250)
Anion gap metabolic acidosis
Hyperkalemia

56

Non-blood observations of a DKA patient?

Fruity breath
Kussmal respirations
Dehydration
Mental status changes
Nausea, Vomiting

57

How is DKA treated?

Fluids, Insulin, Electrolyte Replacement

58

Other than DKA, complications of Diabetes Mellitus

Vascular endothelium damage
Microcirculation destruction
Blindness
Peripheral neuropathy
Erectile dysfunction

59

How does hyperosmolar non-ketotic hyperglycemia present?

Sugars over 500
Life threatening diuresis
Hypotension, coma
No ketones

60

Three structures more prone to suffer osmotic damage in diabetics?

Schwann cells
Pericytes of retinal blood vessels
Lens

61

Why is the lens a concern in hyperglycemia?

The lens takes up sugar without insulin

62

Blood values of a patient with an insulinoma?

Low Glucose
Increased C-Peptide Levels
Increased Insulin Levels

63

What is a gastrinoma?

Gastrin secreting tumor of the pancreas

64

Symptoms of somatostatinoma?

Achloryhydria (inhib. of gastrin)
Inhibition of CCK
Cholelithiasis and steatorrhea

65

Symptoms of VIPoma?

Excessive VIP secretion
Watery diarrhea, hypokalemia, achlorhydria

66

Major complications of Type II diabetes

Stroke, Visual Impairment
Heart Disease, Kidney Disease
Skin infections, gangrene
Hardening of arteries, autonomic neuropathy
and more :D