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 THE
PANCREAS
TYPES OF TISSUES

1.Acini ± secretes digestive juices

2.Islets of Langerhans- has 3 types of cells namely

a. Alpha cells ± 25% - secrete D

[.Beta cells ± 60% - secrete 

and  
c. Delta cells ± 10% - secrete  
d. PP cells ± secrete  
  
 INSULIN ± Hormone Associated with
Energy A[undance

1.Effect on Car[ohydrate Meta[olism

A. Promotes Muscle Glucose Uptake and Meta[olism

-Storage of Glycogen in Muscle

B. Promotes Liver Uptake, Storage and Use of Glucose

Mechanisms:

 

 
[. causes 




 from the
[lood [y the liver cells ([y  


  


  
 
C. increases activity of enzyme  
  , that
promote glycogen synthesis

- Glucose is released from the liver [etween meals

Lack of insulin activates   , which
causes splitting of glycogen into glucose phosphate

- Insulin promotes Conversion of Excess Glucose into

fatty Acids and   
D
  in the
liver
x Lack of Effect of Insulin on Glucose Uptake and Usage
by the Brain
2. Effect on Fat Meta[olism
A.Insulin promotes Fat Synthesis and Storage
Ñ Storage of Fat n the Adipose Cells
 

  

 

  


















 
B. Insulin deficiency Causes Increase Meta[olic Use of Fat
causing

a 
    of Storage Fat and Release of Free Fatty
Acids
[. Increase Plasma Cholesterol and Phospholipid
c. Excess Usage of Fats during Insulin Lack Causes
  and   
3. Effect of Insulin on Protein Meta[olism
A. INSULIN PROMOTES PROTEIN Synthesis and Storage

a. stimulates transport of amino acids into the cells

( 

 
 
 
  

   X
[. increases the translation of messenger RNA,
forming new proteins
c. increases the rate of transcription of DNA genetic
sequences in cell nuclei
d. inhi[its cata[olism of proteins
e. depresses the rate of gluconeogenesis
 INSULIN PROMOTES PROTEIN FORMATION AND
PREVENTS DEGRADATION OF PROTEINS

B. Insulin Lack Causes Protein Depletion and Increased

Plasma Amino Acids
Ñ protein wasting is one of the most serious of
all effects of severe dia[etes mellitus

C. Insulin and Growth Hormone Interact Synergistically to

Promote Growth
MEx
ANISMS OF INSULIN
SExRETION
 CONTROL OF INSULIN SECRETION

1. Increased Blood Glucose Stimulates Insulin secretion

u Other Factors That Stimulate Insulin Secretion:
a Amino Acid ± most potent are V
 and 
- 

V




  
     
 

b Gastrointestinal
ormones ± V

 
  

V




c Other
ormones-  V
 

  

  

 V


d Autonomic Nervous System
-Stimulation of the parasympathetic nerves to the pancreas can
increase insulin secretion
 Role of Insulin in ³Switching´ Between Car[ohydrate
and Lipid Meta[olism

D !D"#± a hormone secreted [y the  

 
of
the islets of Langerhans when [lood glucose
concentration falls. Its important function is to 

 


 
thus is also called the
$   
$
 Effects on Glucose
Meta[olism

Major Effects
1. [reakdown of liver glycogen    X

2. 

 
in the liver
 ther Effects (when conc. rises a[ove maximum
normally found in the [lood

1.activates adipose cell lipase- increasing fatty acids

availa[le to the energy system of the [ody

2.inhi[its storage of triglycerides in the liver

3. enhances the strength of the heart

4. increases [lood flow in some tissues, esp. kidneys

5. enhances [ile secretion

6. inhi[its gastric acid secretion

 Regulation of Glucagon Secretion

a. Increased Blood Glucose Inhi[its Glucagon Secretion

Ñ the most potent factor that controls glucagon secretion

Ñ 


 







 
 
%

 
  







 

 

[. Increased Blood Amino Acids Stimulate Glucagon

Secretion (especially   

  X
 SOMATOSTATIN INHIBITS GLUCAGON
AND INSULIN SECRETION

Factors Related to Ingestion of Food Stimulate

Somatostatin Secretion:

1. Increased [lood glucose

2. Increased amino acids
3. increased concentrations of GI hormones
4. increased fatty acids
Inhi[itory Effects of Somatostatin:

1. Acts on the islets of Langerhans to depress the

secretion of insulin and glucagon

2. decreases the motility of the stomach, duodenum and

gall[ladder

&
  
' 

 ( is to
extend the period of time over which the
food nutrients are assimilated into the
[lood
 SUMMAR Y F BLD GLUCSE REGULATIN
Mechanisms:

1. The liver functions as an important [lood glucose [uffer

system
2. Both insulin and glucagon function as important
feed[ack control systems for maintaining a normal
glucose concentration
3. Severe hypoglycemia stimulates the sympathetic nervous
system
ë Growth hormone and cortisol are secreted in response to
prolonged hypoglycemia, decreasing the rate of glucose
utilization by most cells
Importance of Blood Glucose Regulation:

1. Glucose is the only nutrient that normally can [e used

[y the  
  and  
 






2. Blood glucose should not too high (reasonsX

a. glucose exert a large amount of osmotic pressure in
the ECF causing cellular dehydration
[. high levels of [lood glucose concentration causes loss
of glucose in the urine
c. causing osmotic diuresis [y the kidneys
d. long-term increase in [lood glucose cause damage to
many tissues, esp. [lood vessels. Vascular injury
leads to heart attack, stroke, end-stage renal
failure and [lindness
DIABETES MELLITUS

It is a syndrome of impaired
car[ohydrate, fat, and protein meta[olism
caused [y either 

 or 

   
 
 




Types of Diabetes Mellitus:

1. & 
)
* - also called 
 dia[etes
mellitus (IDDMX, is caused [y lack of insulin secretion.

2. & 

*  ± also called  

 dia[etes
mellitus (NIDDMX , is caused [y decreased sensitivity of
target tissues to insulin. This reduced sensitivity to
insulin is often referred to as 

 
 Type I Dia[etes- Lack of Insulin
Production [y Beta cells of the Pancreas

CAUSES:

1. Viral Infection or Autoimmune Disease ± may [e

involved in the destruction of the [eta cells

2. Heredity


  
   
  
0



  
 

 



Principal Sequelae:

0Y  
 

Y 
 


 



 
  

Y  
    
Blood Glucose Concentration Rises to Very
High Levels in Dia[etes Mellitus

Increased Blood Glucose Causes Loss of Glucose in

the Urine

Increased Blood Glucose Causes Dehydration

" 

 

 




%

  


    +
Chronic High Glucose Concentration
Causes Tissue Injury:

Blood vessels function a[normally resulting

to inadequate [lood supply to tissues
leading to risk 

,   

 
 ,   and  , and
  and 



Damage to tissues causing  


(a[normal function of peripheral nerves, and

 

  
 
 

$  
secondary to renal injuryX
and     (secondary to
a[normal lipid meta[olismX
Dia[etes Mellitus Causes Increase Utilization of Fats
and Meta[olic Acidosis leading to coma and death

As a result the patient develops severe meta[olic

acidosis leading to coma and death

Ñ    ± increased deposition of cholesterol

in the arterial walls
Ñ A

 
  Ñ rapid and deep breathing ±
physiologic compensation in metabolic acidosis
Dia[etes Causes Depletion of Body¶s
proteins

- rapid weight loss and   (lack of

energyX despite of eating large amounts of food
  X
Type II Dia[etes ± Resistance to Meta[olic
Effects of Insulin

Ñmore common than type I ± to 90% of all cases of

dia[etes
Ñnset occurs after the age of 30, often [etween 50 t0 60
years
 referred to as 

"
* 
 related mainly to the increasing prevalence of   




 


 

 


 

,




Obesity, Insulin Resistance and ³Metabolic

Syndrome´ Usually Precede Development of Type II
Diabetes
Features of Metabolic Syndrome

0Y    

 




Y 
  
Y   
Y !  
  
  "
     "  
#Y    
 Other Factors That cause Insulin
Resistance and Type II Diabetes

0Y $ %&$'%(

Y )* 
 

  
&'
%(+ 
&(

Development of Type II Diabetes During

Prolonged Insulin Resistance
Physiologic Diagnosis of Diabetes
Mellitus

1 Urinary Glucose
u Fasting Blood Glucose and Insulin Levels
- in the early fasting blood glucose level is
normally 80 to 90 mg/100 ml
-110 mg/100 ml to be the upper limit
Ô 

 


 
 
 

Ñ type I dia[etes ± plasma insulin levels are
very low or undetecta[le during fasting and
after a meal
type II dia[etes ± plasma insulin concentration
is higher than normal

3. Glucose Tolerance Test

4. Acetone [reath
TREATMENT F DIABETES:

A.Type I dia[etes ±administer enough insulin

B. Type II dia[etes
Ñdieting and exercise
Ñdrugs
Insulinoma ± Hyperinsulinism

Ñ occurs from an adenoma of an islet of Langerhans

Ñ insulin shock and hypoglycemia

Ñ as [lood glucose level falls into the range of 50 to 70

mg/dl the CNS [ecomes excita[le leading to
hallucinations, extreme nervousness, trem[les
all over, [reaks out in a sweat
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