Organisation of the Body
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Regulation of blood glucose levels | show 🗑
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Anatomy of the pancreas | show 🗑
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Innervation | show 🗑
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show | Clusters of 1000 endocrine cells
1 million islets in a human
Different islet endocrine types; alpha (glucagon), beta (insulin), delta (somatostatin), PP-cells (pancreatic polypeptide) and epsilon (Ghrelin)
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show | Gene located on chromosome 11
Expressed as preproinsulin and processed to make mature insulin
Cleavage of C-peptide occurs in the golgi
Mature insulin stored in secretory vesicles - 8fg per granule
10000 granules per beta cell
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show | Increase in glucose moving in through GLUT1/2
Converted to ATP through oxidative metabolism
ATP blocks potassium ATP channels
Cell depolarises opening CVGGs
Leads to exocytosis of vesicles
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show | Initial rapid rise in insulin conc following glucose consumption
Continues to increase over the next 2 hours as glucose moves into cells
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show | Stimulated by increased blood glucose
Inhibits release of glucose from the liver
Promotes uptake of glucose into muscle and fat
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show | Increased blood glucose
PSNS
Amino acids
Fatty acids
Glucagon
Gastrointestinal hormones
SNS and Somatostatin inhibit
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show | Tyrosine kinase
Dimerises on activation and auto phosphorylates
Inserts GLUT4 into membrane
Enzymes involved in metabolic pathways are activated or inactivated
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show | Carbohydrate metabolism - GLUT4, glycolysis, glycogenesis, inhibits gluconeogenesis and glycogenolysis
Protein metabolism - stimulates AA uptake and protein synthesis
Lipid metabolism - Stimulates lipogenesis and inhibits lioplysis
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Action of insulin on K | show 🗑
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show | GLUT1 - plasma membrane of all cells - glucose, galactose and mannose
GLUT2 - intestine, kidney etc - glucose and fructose
GLUT3 - everywhere - glucose
GLUT4 - muscle - glucose
GLUT5 - gut - fructose
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show | SGLT1 - intestine and kidneys = (2 NA for 1 glucose)
SGLT2 kidney - (1 Na for 1 glucose)
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Incretin hormones | show 🗑
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show | Healthy - incretin hormones are responsible for glucose secretion
Diseased - K atp channels responsible for glucose secretion
GIP pathway not active in diabetics - explains why metformin has no effect on healthy cells
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Release of incretin hormones | show 🗑
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show | Inhibits glucagon secretion
Stimulates insulin secretion
Decreases appetite
Inhibits gastric emptying
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show | Glucagon - pro-glucagon - GLP1 by prohormone convertase 1/3
secreted
GLP1 - small peptides - amino acids by dipeptidyl peptidase IV
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Alpha cells and glucagon | show 🗑
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show | Decreased blood glucose
SNS
AAs
GI hormones
inhibited by somatostatin and insulin
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Glucagon receptors | show 🗑
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show | Inhibitory polypeptide found in brain, GI tract and islets
Cleaved from prosomatostatin - 14aas in brain and 28 aa in islets
Pancreatic inhibitor of insulin and glucagon secretion - brake on islet cell activity
Inhibitory Gas GPCR
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show | Urine output increases
Urine contains raised amounts of glucose
Caused by lack of glucose
Type 1 - lack of insulin
Type 2 - resistance to insulin and collapsing b cell function
More than one cause of type 2
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show | Normal fasting plasma glucose - 3.5-5.5 mM
Considered hypoglycaemic if <4 mM
Diagnosis of diabetes if > 7 mM
Normal individuals clear glucose in 2 hours diabetic >11.1 mM after 2 hours
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show | Type 1 - immune destruction of B cells
Neonatal - mutations in K atp channels
Type 2 - impaired b cell function and defective insulin signalling in metabolic syndrome
Gestational diabetes
Maturity onset diabetes of young people - mutations in 6 genes
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show | Insulin dependent
Immune destruction of beta cells
Complete lack of insulin signals starvation increasing gluconeogenesis and glycolysis
Ketogenesis is upregulated
Peak incidence 12-14
Genetic and environment play a role
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Type 2 diabetes | show 🗑
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show | Gangrenous foot - poor blood and nerve supply
Neuropathy in retina leading to blindness
Kidney damage - primary cause of death
Albumin detected in urine due to podocyte damage
Results from glycosylation of proteins in high plasma glucose
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Glycosylated haemoglobin | show 🗑
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Glycation | show 🗑
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