Pancreas physiology and diabetes mellitus

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In the fasting state glucose is ____ mg/dL and fatty acids are ____ µM. In the fed state glucose is ____ mg/dL and fatty acids are ____ µM.

<100, 400, 120-140, <400

Pancreatic islet cells comprise ____% of pancreatic physiology


Alpha cells make up ____% of total islet cells and secrete ____ in response to ____.

15-20, glucagon, hypoglycemia

Beta cells make up ____% of total islet cells and secrete ____.

60-85, insulin

Delta cells make up ____% of total islet cells and secrete ____.

3-10, somatostatin

____ can be used to determine if a patient is synthesizing endogenous insulin or if the source is exogenous

C peptide

The insulin receptor is a ____ composed of alpha/beta subunit dimers

receptor tyrosine kinase

Erythrocytes have ~____ insulin receptors per cell while adipocytes and hepatocytes have ~____ insulin receptors per cell

40, 300,000

The ____ subunits inhibit the inherent tyrosine phosphorylation of the ____ subunits of the insulin receptors

alpha, beta

Insulin receptor activation stimulates cell growth, protein synthesis, glycogen synthesis and translocation of ____ enriched vesicles to the cell membrane


Under low glucose conditions, the ____ pumps pancreatic alpha-cells are not as active, SOC are activated to increase intracellular Ca2+ that depolarizes the cell to release glucagon


____ and ____ are GI hormones released after meals and stimulate insulin secretion

Glucagon like peptide-1 (GLP-1), gastric inhibitory peptide (GIP)

With T1DM, ____ cell destruction leads to loss of ____ production, further leading to increased HbA1C (glycated Hb), polyphagia, polydipsia, polyuria

beta, insulin

In T2DM, insulin may be present but it is not released properly or does not act appropriately, with relative insulin ____


Other than the traditional type 1 and type 2 of DM, diabetes can be caused by carbohydrate intolerance associated with genetic syndromes e.g. ____


Hyperlipidemia can occur with DM due to unopposed action of ____ in adipose tissue

hormone sensitive lipase

Diagnostic criteria of diabetes includes any of the following: -Symptoms of diabetes plus a casual plasma glucose concentration ≥ ____ mg/l (11.1 mM) -fasting BP ≥ ____mg/dl (7.0 mM) -2hPG ≥ ____ mg/dl during an OGTT HbA1c ≥ ____%

-200 -126 -200 -6.5%

Patients with T1DM have antibodies against ____ and to ____.

pancreatic beta-cells, glutamic acid decarboxylase

The major susceptibility gene for T1DM is located in the ____ on chromosome 6, with polymorphisms accounting for ____% of the genetic risk of developing type 1

HLA complex, 40-50

The HLA complex contains genes that encode the ____, which present antigen to helper T cells and thus are involved in initiating the immune response

class II MHC molecules

T2DM has a strong genetic component with over ____ genetic loci identified


T2DM is characterized by insulin resistance in which ____, ____, and ____ are refractory to the action of insulin to maintain glucose levels within the normal range

liver, skeletal muscle, adipose tissues

Thiazolidinediones act on the peroxisome proliferator-activated receptors (PPARs), particularly PPAR-gamma, which is involved in lipid metabolism and glucose ______


____ slow the inactivation of incretin hormones, such as GLP-1 and GIP, which stimulate insulin secretion and inhibit glucagon secretion

DPP-4 inhibitors

____ decrease the reabsorption of glucose in the proximal tubules of the kidneys, leading to increased urinary glucose excretion.

SGLT-2 inhibitors

Thiazolidinediones have been associated with an increased risk of cardiovascular events and heart ______


SGLT-2 inhibitors have been associated with an increased risk of urinary tract infections and diabetic ______


Biguanides improve insulin sensitivity, reduce hepatic glucose production, and increase insulin secretion. The primary example of biguanides is ________.


_____ stimulate insulin release from the pancreas.


Adverse effects of metformin include nausea, vomiting, and ________, which typically resolve within a few weeks.


Common side effects of sulfonylureas include hypoglycemia, weight gain, and ________.

hypoglycemic unawareness

Oral ____ agents are medications used to manage blood sugar levels in people with T2DM.


Parenteral ______ are typically administered using an injection pen, which allows for easy and convenient self-injection. These pens come in a variety of sizes and colors, and many have features like a visual guide to ensure proper injection depth and a built-in needle guard.


Amylin ______, such as pramlintide, are injectable medications that help improve glycemic control in individuals with type 2 diabetes. These medications work by mimicking the action of amylin, a hormone that helps regulate blood sugar levels after meals. Pramlintide is typically injected before meals and has been shown to reduce post-meal blood sugar levels and improve glycemic control.


Some forms of neonatal diabetes are caused by mutations in ____ channel on beta-cells or mutations in the insulin gene

inward rectifying K+

Most patients with MODY are treated with ____.


Chronic diseases of the pancreas (pancreatitis), _____, or endocrinopathies (acromegaly and Cushings disease) can cause diabetes

cystic fibrosis

gestational DM affects between ____% of all pregnancies


D Burkin Block 3 week 4

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