·         Secretes hormones that regulate metabolism

·         CONTROLS

o   Glucose

o   Proteins

o   Fats

•          Brain and Nervous System use of glucose?

–        Use only glucose-can’t use fats/proteins..Have to have Glucose supply

–        Can’t synthesize or store Glucose so brain and nervous system depend on constant supply

•          After eating-stored in liver & muscle as glycogen

–        As levels fall, liver can release sugar

–        Muscles can’t release glucose but can use

–        Liver can create glucose from amino acid, glycerol, lactic acid

•          Excess converted to fat and stored in tissues

•          Stored as triglycerides

–        A molecule of glycerol that links 3 fatty acids

–        Broken down in liver by lipase so we can save fatty acids here   

•          Efficient storage of fuel

•          Stored as triglycerides

         Fatty acids used for energy like glucose

               Large amounts of fatty acid breakdown

Fatty acids are converted to ketones (acidic)

•          Essential for the formation of all body structures

–        Made of amino acids

•          If glucose is not available

–        Proteins broken down  in the liver to create glucose

The Pancreas 2 Functions

·         Exocrine

·         Endocrine

o   Endocrine pancreas Islets of Langerhans Release these hormones...

ALPHA

BETA

DELTA

GUT DERIVED

§  Alpha- Glucagon

§  Beta- Insuline and Amylin

§  Delta Cells- Somastastin

§  Gut Dervived Hormones- Incretin effect gut also helps create glucagon not all about insuline

Pancreatic Hormones

•          Glucagon: the liver to release stored glucose

–        Glycogenolysis-break down of glycogen into glucose

–        Gluconeogenesis-creation of glucose from fats and proteins

•          Insulin: increases cells ability to take up glucose from the blood

•          Amylin: slows glucose absorption in small intestine; suppresses glucagon secretion

•          Somatostatin: decreases GI activity; suppresses glucagon and insulin secretion

Normal Metabolism anabolism vs Catabolism

·         Anabolism

o   Insuline

§  Used in cells

§  StOred resources glycogen

§  Proteins

§  Triglycerides

·         Creates stabilizes and builds protein and fat

·         Catabolism

o   Glucogon- Cortisol

§  Make resources available in the blood

§  Liver converts amino acids and free fatty acids  into ketones when there is too much

2 problems that are associated with Insuline and leads to diabetes?

·         Absent

·         Ineffective

Diagnostic Criteria for diabettes

•          Symptoms

–        Poly- Dipsea, Phagia, Urea

–        Casual blood glucose > 200mg/dL

•          Fasting blood glucose >126mg/dL

•          Tolerance

–        2hr post load blood glucose > 200mg/dL

–        Load is 75 grams

•          Hemoglobin A1C <7%

Types of Diabetes Milltus

•          Type 1: pancreatic beta cell destruction predominantly by an autoimmune process

•          Type 2: a combination of beta cell dysfunction and insulin resistance

–        Genetic defects in insulin production

–        Genetic defects in insulin action

–        Diabetes secondary to other diseases

–        Drug interactions

–        Gestational diabetes mellitus

Lack insuline what happens to your?

BG levels

Amino Acid Levels?

Blood PH?

Fat levels?

Cell Growth?

increase

increase

decrease

decrease

Decrease

Type 1- Absolute Deficiency- Leads to DKA

·         Cellular demand increases Glucogon production

·          Hunger... Eat like crazy lose weight

·         Gluconeogenesis and Glycogenolysis

·         Blood sugar levels are high

·         osmotic diuresis... HUGE BS molucuses filling up blood and pulls fluid in vasular space

·         loss of protein, glucose, Na+, Mg+, PO4 with diuresis

·         Thirst, urination

·         Leads to vascular collapse-hypovolemia

Type 1- Absolute Deficency DKA

•          Need for energy causes lipolysis of adipose

–        increased release of fatty acids

•          Liver deals with excess FFA by metabolizing them to keto acids

–        Rise in keto acids decrease pH of blood-metabolic acidosis

–        Respiratory compensation increase resp with a fruity smell-keto acids

–        Extra cellular H+ is exchanged for intracellular  K+  (hyperkalemia)

–        CNS dysfunction-coma, death

Two Problems with DKA

·         Metabolic Acidosis

o   CNS Depression

o   COMA

·         HyperGlycemia- DECREASE FLUID VOLUME

o   Osmotic Diureses

o   Water electrolyte loss

o   Dehydration

o   Cir failure

Diabetic Ketacidosis- Treatment

•          Treatment

–        Insulin

–        Fluid replacement

•          Hypotonic to replace intracellular loss (slowly)

•          Change to Isotonic as dehydration is relieved

•          May need to add bicarb to IV (NaHCO3-)

–        Electrolyte replacement

•          Check q 1 hour

•          K+ high levels, insulin and fluid will decrease levels very quickly

•          Na+, Ca+, PO4, Mg

TYPE 2

Pathogenesis of Type 2 Diabetes… Issues Behind insuline

·         Impaired  insulin secretion

·         Carbohydrate absorption

·         Increased basal hepatic glucose production

·         Decreased Insuline- stimulation glucose uptake

HHS: Hyperglycemic, Hyperosmolar State

•          Hyperglycemia

             cells can not use, liver does not store

             Glucogon: released r/t cellular demand

•          Osmotic diuresis polydipsia, polyphagia

•          The presence of endogenous insulin prevents the large production of keto acids from adipose tissue

•          Vascular collapse: hypovolemia & electrolyte imbalance

Complications of DM

•          Vascular

–        Macrovascular-large vessel damage

•          Stroke, artherosclerosis, ACS, MI

•          50-75% of Type II DM patients die of macrovascular complications

–        Microvascular-thickening of basement membranes of capillaries

•          Abnormal glycoprotein formation disrupts normal structures

•          Retinopathy, nephropathy

Diabetic Neuropathy

•          Somatic neuropathy

–        Diminished perception of vibration, pain, and temperature

–        Hypersensitivity to light touch; occasionally severe “burning” pain

•          Autonomic neuropathy

–        Defects in vasomotor and cardiac responses

–        Impaired motility of the gastrointestinal tract

–        Inability to empty the bladder

–        Sexual dysfunction

Osmolarity in Diabetes Mellitus

•          When blood glucose is high, increased blood osmolarity can cause cells to shrink

Nerve cells produce intracellular osmoles to keep their osmolarity balanced with the blood

Osmolarity in Diabetes mellitus

•          When blood glucose returns to normal, the nerve cells are hyperosmolar to the blood and gain water, swelling

•          Nerve damage may be caused by swelling, demyelination, and lack of O₂ secondary to vascular disease

Foot Ulcers

•          Neuropathy

–        Unaware of trauma

•          Vascular disease

–        Decreased circulation

•          Infections

Diabetes Treatment

•          Nutrition

–        Protein-10-20% of calories

–        Fat-10% saturated, 10% polyunsaturated

–        Carbohydrates-60-70%

•          Exercise

–        Increase glucose use and weight control

–        30 minutes moderate intensity daily

•          Continuous or intermittent

•          Increase muscle use glycogen

•          Can last for several hours afterwards

Diabetes Treatment

•          Stress Management

–        Decrease stress response

•          Education (Hemoglobin A1C)

•          Medications

–        Oral agents

•          Increase insulin output

•          Decrease liver production

•          Decrease insulin resistance

•          Delay carbohydrate absorption

–        Injectable meds-enhance action of insulin

•          Pramlintide/Symlin Exenatide/Byetta

•          Incretin analogues

Goal

·         Glycemic control with insulin

Metabolic Sydrome- Insuline Resistance

•          Abdominal obesity: waist >88cm(f)  102(m)

•          Increased triglycerides: >150mg/dL

•          Decreased HDL levels: <40(f) 50(m) mg/dL

•          Increased blood pressure: >130/85

•          Increased fasting glucose: > 100 mg/dL

•          Pro-thrombotic state

–        high fibrinogen or plasminogen activator inhibitor–1

•          Pro-inflammatory state

–        elevated C-reactive protein in the blood