Pancreas

Question 1

pancreas secretions

Answer 1

insulin
glucagon
somatostatin
pancreatic polypeptide

Question 2

beta cells

Answer 2

insulin

Question 3

alpha cells

Answer 3

glucagon

Question 4

delta cells

Answer 4

somatostatin

Question 5

remaining cells

Answer 5

pancreatic polypeptide

Question 6

insulin structure

Answer 6

peptide hormone

A and B chains linked two disulfide bonds

Question 7

C peptide

Answer 7

secreted with insulin

-good marker of insulin secretion from beta cells

Question 8

insulin action

Answer 8

up-regulates GLUT-4 transporters
-muscle and adipose tissue

promotes formation of glycogen in liver and muscle

inhibits glycogenolysis and gluconeogenesis

decreased FA and ketoacid concentration in blood

stimulates fat deposition and inhibits lipolysis

promotes K uptake into cells

Question 9

GLUT 2

Answer 9

low affinity

• pancreatic beta cells
• ilver
• intestine
• kidney

Question 10

GLUT 1 and 3

Answer 10

allow glucose to go to brain

Question 11

GLUT 4

Answer 11

skeletal muscle and adipose

insulin-responsive

Question 12

insulin and potasslum

Answer 12

promotes movement of potassium into cells

Question 13

high insulin:glucagon

Answer 13

anabolic state

Question 14

low insulin:glucagon

Answer 14

catabolic state

Question 15

insulin deficiency

Answer 15

leads to ketosis

Question 16

oral vs. IV glucose

Answer 16

oral more powerful

-bc GIP release increases effect of insulin

Question 17

DM I

Answer 17

insulin-dependent - destruction of beta cells
increased blood glucose, FA, ketoacids, AA
increased ketoacids
metabolic acidosis (diabetic ketoacidosis)
polyuria
hyperkalemia

Question 18

DM I and polyuria

Answer 18

glucose is an osmotic diuretic

Question 19

DM II

Answer 19

insulin-independent - associated with obesity
insulin resistance
normal insulin levels, no response
blood glucose elevated fed and fasting states
Tx: caloric restriction, weight reduction, sulfonylurea drugs and biguanide drugs

Question 20

biguanide drugs

Answer 20

upregulate receptors for insulin

Tx for type II DM

Question 21

glucagon secretion

Answer 21

stimulated by low blood glucose
inhibited by insulin
stimulated by protein ingestion (Arg, Ala)
stimulated by fasting and exercise
stimulated by alpha-adrenergic stimulation

Question 22

action of somatostatin

Answer 22

from delta cells
inhibit secretion of insulin and glucagon

modulate response of insulin and glucagon

Question 23

type I DM

Answer 23

immune mediated
beta cell destruction

insulin dependent
ketoacidosis**

Question 24

type II DM

Answer 24

insulin resistance

overweight, usually no ketoacidosis

Question 25

gestational DM

Answer 25

during pregnancy

Question 26

diabeticogenetic effect

Answer 26

acromegaly and hypercortisolism

Question 27

family Hx

Answer 27

more with type II DM

Question 28

obesity

Answer 28

BMI > 30 kg / m~2

Question 29

pre-diabetic

Answer 29

fasting 100-126 | 2 hour oral glucose tolerance 140-200

Question 30

criteria for diabetes Dx

Answer 30

fasting oral glucose tolerance random glucose hemoglobin A1c

Question 31

incretin effect

Answer 31

oral glucose - stimulates GLP-1 -potentiates insulin release from beta cells no GLP-1 with IV

Question 32

glucagon and incretins

Answer 32

glucagon, GLP-1, GLP-2 from same gene

Question 33

amylin

Answer 33

also from beta cells suppress appetite inhibit gastric emptying

Question 34

type 2 diabetics

Answer 34

reduced incretin effect can use GLP-1 agonists

Question 35

fruity odor on breath

Answer 35

indicative of ketones

Question 36

type 1 DM

Answer 36

cell mediated autoimmune T cell mediated** predictable with islet autoantibodies

Question 37

pre-diabetes

Answer 37

beta cell mass decreases | after autoantibodies present

Question 38

genes associated with type I DM

Answer 38

HLA also INS, PTPN22 insulin in thymus - protective - recognize as self

Question 39

MHC

Answer 39

``` class II - DP DQ DR class I - B C A ```

Question 40

major islet autoantigens

Answer 40

ZnT8 IA-2 GAA mIAA

Question 41

diabetic ketoacidosis

Answer 41

C peptide of zero

Question 42

common to DM I and DM II

Answer 42

nonenzymatic glycosylation of proteins