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64 Cards in this Set

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What type of a gland is the pancreas?
a MIXED gland of endocrine and exocrine tissue, in a ratio of about 98% to 2%
What does the pancreas produce PRIMARILY, and what else?
Primarily enzymes and bicarbonate for digestion. Also produces some hormones.
What are the functional pancreas units called, and what cells are in them?
Islets of Langerhans; contain alpha, beta, delta, and F cells.
What do each cells produce?
-Alpha
-Beta
-Delta
-F
A = Glucagon, 20%
B = Insulin, 70-90%
D = Somatostain, 5%
F = Pancreatic polypeptide, 1%
What is pancreatic polypeptide, and what does it do?
A hormone produced by the pancreas that acts on the pancreas; thus a PARACRINE hormone; influences secretion by the alpha/beta cells.
What is the Absorptive state?
The time after a meal when you absorb it; approx. 4 hrs; the time during which body cells are mainly using GLU for energy.
What is the Post-absorpt state?
PAS: you're not using the meal's glucose, so need to maintain plasma glucose levels
why do plasma glu levels need to be maintained during PAS?
To supply the brain which only uses Glu for energy, not fatty acids.
What are the 2 main ways the body maintains blood glu levels?
1. Cells use FA for energy, so it spares glucose.
2. Stored nutrients are broken down by Glycogenolysis and Gluconeogenis.
What are the 2 ways to put glucose into the plasma?
1. Glycogenolysis
2. Gluconeogenis
What are the 3 things that happen to glucose during the AS?
1. Some used by cells as fuel
2. Converts to Triglycerides/fat
3. Converts to glycogen
What is the proess of glu converting to glycogen?
What catalyzes this, and where?
Glycogenesis; catalyzed by Glycogen Synthase, stored in the liver and muscle.
What are Triglycerides made of, and where?
Fatty acids and Glycerol. In the liver.
how does Glucose get to the liver in the first place?
By the hepatic portal vein from the intestine.
how can the liver make glucose, and what is this process called?
By synthesizing it from amino acids and glycerol; Gluconeogenesis.
What happens with glucose during the PAS?
It is MADE - Glycogenolysis
How is glucose made during PAS?
What enzyme catalyzes it?
By break down of glycogen; Glycogen phosphorylase.
What state does Insulin control?
What processes?
The absorptive state, so -Carbohydrate syntheis and
-Glucose uptake by Fat, Liver, and Muscle cells.
What is necessary for glucose uptake by muscle/fat cells?
GLUT 4
What is GLUT 4?
A carrier molecule that transports GLucose across the cell membrane; made in the cytoplasm and released by vesicular transport.
What is necessary for insulin to communicate with target cells?
Insulin receptor, a phosphokinase.
What happens when Insulin binds its receptor?
It phosphorylates a Protein, THE CARRIER OF GLUT4, and allows it to be translocated to the membrane.
Why does the brain use glucose independent of insulin?
Because it doesn't need this Glut4 to take up glucose.
What stimulates the translocation of GLUT4?
Exercise
In a nutshell, what are the 3 actions of insulin w/ respect to carbohydrates?
1. Increase Carb metabolism
2. Stimulate glycogen synthesis
3. Inhibit gluconeogenesis
In a nutshell, what are the 3 actions of insulin w/ respect to protein?
1. Increases Amino Acid uptake by cells
2. Increases Protein synthesis (as needed)
3. Decreases protein degradation
How does insulin affect lipid metabolism?
It increases LPL in the capillaries, so more chylomicrons and VLDLs are taken up into adipocytes to make tryglycerides.
Other than activating LPL, how does insulin affect lipid mtbsm?
Inhibits hormone sensitive lipase, so lipids aren't broken down.
What stimulates Hormone sensitive lipase?
Growth hormone - so you use fat when you want to grow.
Why is insulin so significantly important?
Because it's the ONLY HORMONE that can act to decrease plasma glucose levels; if it's lacking, you'll have a problem.
What is the #1 important controller of insulin secretion?
Plasma glucose levels - the very thing insulin itself controls.
What reduces insulin stimulation?
Negative feedback - decreased plasma glucose levels when insulin does its job.
How does digestion/absorption control insulin secretion?
Stimulated - by the increased presence of Amino acids, gastric hormones, and plasma glucose.
How is insulin secretion affected by
-PNS
-ANS
-Parasympathetic nerves increase digestion, thus stimulate insulin secretion.
-Sympathetic nerves inhibit insulin so you can fight/flight.
Along with the SNS, what inhibits insulin secretion?
Somatostatin from the pancreas.
What type of regulation occurs when the PNS stimulates insulin?
Feedforward.
In general terms what is the effect of lack of insulin?
Metabolic disregulation
With regard to time, what are effects of insulin deficiency?
Shorterm: metabolic disregulation.

Longterm: neural, vascular complications.
what is the most common endocrine disorder?
Diabetes mellitus.
What is Type 1 diabetes mell?
-What population gets it? What percentage of all diabetes?
Insulin-DEPENDENT; an autoimmune disease.
-Juvenile, late-onset - 5-10% of all diabetes cases.
What is Type 2 diabetes mell?
Insulin-INDEPENDENT; much more common, mostly in older people.
What occurs in autoimmune diabetes that you're insulin deficient?
The immune system sees the pancreatic Beta cells as nonself and destroys them.
What occurs in non-insulin dependent diabetes? (two things)
1. Insulin receptor signalling is impaired; the target tissues don't respond to it.
2. Beta cells have a sluggish production of insulin.
Which diabetes is more genetic?
Type 2
Which diabetes has 50% concordance? 100%?
50% concordance - type 1; your twin has 1/2 chance of getting it if you have it.
Type 2 = 100%
How does obesity affect Diabetes type 2?
Makes it worse - obesity deceases GLUT4 translocation to adipocytes, so glycogen and fatty acids aren't taken up.
How do Growth hormone and Cortisol affect insulin activity?
Decrease it - they act as insulin antagonists, thus decrease glucose uptake by cells.
What is Pituitary diabetes?
What is Adrenal diabetes?
Pituit: Overproduction of Growth hormone due to a pituitary tumor, inhibiting insulin.
Adrenal: same, but Cortisol
How does each disease affect blood glucose levels?
Increases them.
What are the two most acute symptoms/complications of diabetes?
1. Decrease or reverse of all the actions insulin SHOULD do.
2. Dilute urine, dehydration, hemoconcentration, low circulation, renal failure, coma/death.
What complication is more seen in Type 1 than type 2 diabetes?
Ketone production and reduced triglyceride synthesis - more LIPOLYSIS (remember type 2 is usually obese); causes METABOLIC ACIDOSIS
what is the fastest killing mechanism of the diabetes complications?
Ketonemia - metabolic acidosis
What are the 2 primary chronic complications of diabetes?
-Vascular
-Neurological
What are the Vascular complications?
Atherosclerosis
-Large vessels obstruction causes heart attack/stroke.
-Small vessel blockage causes BLINDNESS and Kidney failure.
What types of neurological complications occur, how are they detected?
Peripheral neuropathy - the nerves are less sensitive.

-Do foot checks for cuts, gangrene; may have to amputate.
What is insulin shock?
What is its effect?
-Too much insulin in the body; due usually to over-injections.
-Causes too low of blood glucose levels; brain needs Glu to function; coma/death.
What is GLUCAGON'S function?
To prevent too low of blood glucose levels (Hypoglycemia) by acting on the LIVER.
What are Glucagon's two main effects on the liver?
1. Increases Glycogenolysis
2. Increases Gluconeogenesis
How does Glucagon increase glycogenolysis?
By increasing cAMP for the 2nd messenger system.
What is the primary regulator of glucagon secretion?
What is a secondary regulator?
Primary: Decreased plasma glu.

Secondary: Symp nervous system
Other than Insulin and Glucagon, what 3 other hormones that affect metabolism? How, generally?
1. Epinephrine
2. Cortisol
3. Growth hormone
-All act to increase plasma glu
What is Epinephrine's effect on metabolism?
Increases glycogen breakdown.
What is Cortisol's effect on metabolism?
Increases gluconeogenesis.
What are Cortisol and Growth hormone's effects on metabolism?
Act as insulin antagonists to prevent glucose storage.