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Questions and Answers
What is the primary trigger for insulin secretion?
What is the primary trigger for insulin secretion?
How quickly is insulin cleared from the body after being secreted?
How quickly is insulin cleared from the body after being secreted?
What happens to proinsulin during insulin synthesis?
What happens to proinsulin during insulin synthesis?
Which type of cells in the pancreas are responsible for insulin production?
Which type of cells in the pancreas are responsible for insulin production?
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What role does the C-peptide play in the body?
What role does the C-peptide play in the body?
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Which physiological effect is NOT associated with insulin action?
Which physiological effect is NOT associated with insulin action?
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What is the role of insulin receptors in the body's cells?
What is the role of insulin receptors in the body's cells?
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Which of the following statements about insulin secretion is true?
Which of the following statements about insulin secretion is true?
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What role does insulin play in postprandial plasma glucose levels?
What role does insulin play in postprandial plasma glucose levels?
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Which is a physiological effect of glucagon?
Which is a physiological effect of glucagon?
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What is the primary effect of insulin on amino acids?
What is the primary effect of insulin on amino acids?
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How does glucagon act in relation to insulin?
How does glucagon act in relation to insulin?
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What diagnostic criterion indicates diabetes mellitus based on HbA1c levels?
What diagnostic criterion indicates diabetes mellitus based on HbA1c levels?
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What does insulin facilitate in the liver and muscles?
What does insulin facilitate in the liver and muscles?
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What effect does insulin have on potassium transport?
What effect does insulin have on potassium transport?
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Which process is stimulated by glucagon to increase blood glucose levels?
Which process is stimulated by glucagon to increase blood glucose levels?
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What fasting plasma glucose level indicates diabetes?
What fasting plasma glucose level indicates diabetes?
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Which test measures blood sugar two hours after consuming a sugary beverage?
Which test measures blood sugar two hours after consuming a sugary beverage?
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Which condition is characterized by the autoimmune destruction of insulin-producing beta cells?
Which condition is characterized by the autoimmune destruction of insulin-producing beta cells?
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Which of the following factors can trigger the autoimmune response in predisposed individuals for Type 1 diabetes?
Which of the following factors can trigger the autoimmune response in predisposed individuals for Type 1 diabetes?
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What is a key characteristic distinguishing Type 1B diabetes from Type 1A diabetes?
What is a key characteristic distinguishing Type 1B diabetes from Type 1A diabetes?
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Which of the following is NOT a cause of Type 1B diabetes?
Which of the following is NOT a cause of Type 1B diabetes?
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Which blood sugar test result suggests diabetes when measured randomly?
Which blood sugar test result suggests diabetes when measured randomly?
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What childhood onset condition is often referred to as juvenile onset diabetes?
What childhood onset condition is often referred to as juvenile onset diabetes?
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What is the role of advanced glycation end-products (AGEs) in blood vessel health?
What is the role of advanced glycation end-products (AGEs) in blood vessel health?
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How do AGEs affect nitric oxide levels in the body?
How do AGEs affect nitric oxide levels in the body?
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What is one consequence of shunting glucose to the polyol pathway during hyperglycemia?
What is one consequence of shunting glucose to the polyol pathway during hyperglycemia?
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Which tissue complication is associated with the activation of the polyol pathway?
Which tissue complication is associated with the activation of the polyol pathway?
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How does excess sorbitol affect red blood cells?
How does excess sorbitol affect red blood cells?
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What is a potential effect of inappropriate activation of protein kinase C (PKC) at high blood sugar levels?
What is a potential effect of inappropriate activation of protein kinase C (PKC) at high blood sugar levels?
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Which condition can result from AGEs promoting coagulation?
Which condition can result from AGEs promoting coagulation?
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What effect does increased osmotic pressure due to sorbitol accumulation have on cells?
What effect does increased osmotic pressure due to sorbitol accumulation have on cells?
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What effect does PKC activation have on insulin signaling?
What effect does PKC activation have on insulin signaling?
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What does increased capillary permeability due to PKC activation lead to?
What does increased capillary permeability due to PKC activation lead to?
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Which factor is NOT mentioned as influencing the severity of microvascular complications?
Which factor is NOT mentioned as influencing the severity of microvascular complications?
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Advanced glycation end products (AGEs) cause damage primarily through which mechanism?
Advanced glycation end products (AGEs) cause damage primarily through which mechanism?
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Which of the following is a symptom of retinopathy?
Which of the following is a symptom of retinopathy?
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What is likely to happen in nephropathy due to high blood sugar?
What is likely to happen in nephropathy due to high blood sugar?
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What role does the polyol pathway play in cells affected by high blood sugar?
What role does the polyol pathway play in cells affected by high blood sugar?
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Which complication of diabetes is characterized by increased vessel thickening and clotting?
Which complication of diabetes is characterized by increased vessel thickening and clotting?
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What is the first sign indicating potential kidney issues in patients?
What is the first sign indicating potential kidney issues in patients?
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Which of the following is a clinical consequence of atherosclerosis in the coronary arteries?
Which of the following is a clinical consequence of atherosclerosis in the coronary arteries?
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Which factor significantly contributes to the accelerated development of atherosclerosis in diabetic patients?
Which factor significantly contributes to the accelerated development of atherosclerosis in diabetic patients?
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What condition is characterized by narrowing of the renal arteries, potentially leading to kidney problems?
What condition is characterized by narrowing of the renal arteries, potentially leading to kidney problems?
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What is a possible consequence of atherosclerosis in peripheral arterial disease?
What is a possible consequence of atherosclerosis in peripheral arterial disease?
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Advanced glycation end products (AGEs) are associated with which of the following?
Advanced glycation end products (AGEs) are associated with which of the following?
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Which of the following best describes myocardial ischemia?
Which of the following best describes myocardial ischemia?
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What serious condition can result from severe peripheral arterial disease due to lack of blood flow?
What serious condition can result from severe peripheral arterial disease due to lack of blood flow?
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Study Notes
Insulin Physiology Review
- Insulin is a hormone produced by beta cells in the islets of Langerhans in the pancreas.
- It regulates carbohydrate and lipid metabolism, but has minor impact on protein metabolism.
- Insulin has a short half-life and is cleared from the body within 15 minutes of secretion.
Insulin Synthesis
- Preproinsulin: The initial, larger protein form of insulin.
- Proinsulin: Preproinsulin is processed, creating three peptide chains (A, B, and C).
- Insulin: Proinsulin is further processed, removing the C peptide, leaving only the A and B chains bonded together, forming the active insulin.
- C-peptide: The removed peptide; it's a measure of insulin production and may decrease complications in those with diabetes.
Insulin Secretion
- Stimulated by: Higher glucose levels, amino acids, and free fatty acids in the blood.
- Inhibited by: Lower glucose levels and higher levels of insulin itself; this is a feedback mechanism to prevent overproduction.
- Other stimuli: Gastrointestinal hormones (e.g., gastrin, CCK, secretin) and parasympathetic nervous system stimulation can also influence insulin release.
Insulin Action
- Receptors: Found on most cell membranes, enabling cells to receive the insulin signal.
- Structure: Two alpha subunits bind insulin and two beta subunits have tyrosine kinase activity.
- Activation cascade: Binding to the receptor activates tyrosine kinase, triggering further cellular signaling involving other intracellular enzymes like PKB and MAP kinase.
- Glucose uptake: Crucial; Insulin binding moves glucose transporters (GLUT4) to the cell surface.
- General effects:
- Control of postprandial plasma glucose levels: Insulin promotes glucose uptake and lowers blood sugar after eating.
- Promotes glucose storage as glycogen: Excess glucose is stored in liver and muscles as glycogen.
- Fatty acid synthesis and triglyceride formation: Promotes fat storage in adipose tissue.
- Transport of amino acids; stimulates protein synthesis: Transports essential nutrients; builds and repairs tissue.
- Stimulates cell growth and differentiation.
- Facilitates K+ transport: Influences potassium levels.
Glucagon
- Glucagon is a hormone produced by alpha cells in the pancreas.
- It's an antagonist to insulin: It opposes insulin's effects, increasing blood glucose levels primarily through liver action.
- Secretion: Triggered by low blood glucose levels.
- Effects: Promotes glycogen breakdown (glycogenolysis), glucose production from other sources (gluconeogenesis), fat breakdown (lipolysis), and ketone production (ketogenesis).
- Circulation: Primarily affects the liver with limited circulation to other tissues.
Diabetes Mellitus
- Diabetes mellitus: A group of disorders characterized by high blood glucose (hyperglycemia) and difficulty regulating glucose metabolism.
- Diagnostic criteria: HbA1c >6.5% (average blood glucose over 2-3 months), and FPG >126 mg/dL (fasting blood glucose after at least 8 hours). Random plasma glucose >200mg/dL (regardless of timing) also suggest diabetes, especially if symptoms present.
Type 1 Diabetes Mellitus
- Type 1A: Autoimmune-mediated; most common type. The immune system attacks and destroys beta cells, leading to a complete lack of insulin production.
- Autoantibodies and cytotoxic T cells target beta cells for destruction.
- Type 1B: Nonimmune-mediated; Not due to an autoimmune response. Could be related to chronic pancreatitis or cystic fibrosis.
- Causes: A combination of genetic predisposition and environmental factors (e.g., viral infections, dietary aspects, and early introduction of gluten).
Type 2 Diabetes Mellitus
- Type 2 diabetes: Chronic condition where the body doesn't produce enough insulin or doesn't use insulin properly (insulin resistance).
- Risk factors: Genetic predisposition, obesity, older age, ethnicity, PCOS, metabolic syndrome.
Pathophysiology of Type 2 Diabetes Mellitus
- Insulin resistance: Cells don't respond properly to insulin.
- High-calorie/carbohydrate diet: Contributing factor to hyperinsulinemia (high insulin levels).
- Adipokines: Hormones released by fat cells that can contribute to insulin resistance.
- Consequences of insulin resistance: hyperglycemia, osmotic diuresis, hyperosmolarity, dyslipidemia.
Chronic Complications of Diabetes Mellitus
- Advanced glycation end products (AGEs): Formed in the presence of high blood sugar, causing damage to blood vessels.
- Nonenzymatic glycosylation: Modification of proteins, lipids, and nucleic acids in the presence of high blood sugar, altering their structure and function.
- High blood glucose: Leads to advanced glycation end products (AGEs).
- Cause capillary basement membrane thickening: Blocking nutrient exchange between blood and tissues.
- Increased capillary permeability: Leads to fluid leakage from capillaries into surrounding tissues (edema), potentially causing further tissue damage.
Microvascular Disease
- Severity: Influenced by factors such as age, duration of diabetes, and blood glucose control.
- Complications: Retinopathy, nephropathy.
- Pathophysiology: Advanced glycation end products (AGEs), Polyol pathway, inappropriate protein kinase C activation.
Macrovascular Disease (Atherosclerosis)
- Atherosclerosis: Fatty deposits (plaque) build up in arteries, narrowing them and restricting blood flow.
- Contributing factors: Hyperglycemia, dyslipidemia, AGEs.
- Consequences: Coronary artery disease, myocardial ischemia/infarction, cerebral infarct (stroke), renal artery stenosis, intestinal vascular insufficiency, peripheral arterial disease (including skin ulceration, gangrene, amputation).
Neuropathy
- Peripheral neuron dysfunction: Problems in nerves outside the brain and spinal cord, affecting sensation, movement, and organ function.
- Pathophysiology: polyol pathway activation, AGEs, PKC activation, ischemia of peripheral neurons, axonal degeneration, demyelination.
- Clinical consequences: Sensory deficits (tingling, burning, numbness), motor deficits (changes in gait, weakness).
Increased Risk of Infection
- Decreased perfusion: Reduced blood flow in tissues, making them more vulnerable to damage from injury and infection.
- Skin breakdown, impaired vision and sensation are common consequences.
- Glucose as a fuel source, and decreased WBC supply are risk factors for bacterial infections.
- Impaired WBC function: Hyperglycemia can negatively impact white blood cell function, making them less effective at combating infection.
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Description
This quiz reviews the essential aspects of insulin physiology, including its synthesis, secretion, and role in metabolism. Discover how insulin is produced in the pancreas and its regulatory effects on carbohydrates and lipids. Test your knowledge on its structure and functional mechanisms.