1. PANCREAS AND DIABETES Valerija Vrhovnik Mentor: A. Žmegač Horvat

2. Anatomy of pancreas Anatomy of pancreas head head body body tail tail acinar cells acinar cells islets of Langerhans islets of Langerhans pancreatic duct pancreatic duct

3. Pancreas: dual-function gland Exocrine pancreas (acinar cells): Exocrine pancreas (acinar cells): produces digestive enzymes (trypsin produces digestive enzymes (trypsin, chymotrypsin, pancreatic lipase and amylase ) enzymes help further breakdown of carbohydrates, proteins, and fat enzymes help further breakdown of carbohydrates, proteins, and fat

4. Endocrine pancreas Islets of Langerhans 4 types of cells: Islets of Langerhans 4 types of cells: 1) Alpha cells – produce glucagon (hormone); 25% total cells 25% total cells 2) Beta cells – insulin synthesis and secretion; 60% secretion; 60% 3) Delta cells – produce somatostatin (inhibits secretion of other hormones); 10% secretion of other hormones); 10% 4) PP cells – secrete pancreatic polypeptide; <5% polypeptide; <5%

5. Insulin = hormone of feasting small protein composed of two peptide chains small protein composed of two peptide chains

6. Insulin effect on metabolism 1) Carbohydrates: ↑ glucose utilization, ↑ 1) Carbohydrates: ↑ glucose utilization, ↑ CHO storage, use of CHO for energy CHO storage, use of CHO for energy 2) Fats: ↓ use of fat, fat sparer 2) Fats: ↓ use of fat, fat sparer 3) Proteins: ↑ protein anabolism, inhibits 3) Proteins: ↑ protein anabolism, inhibits catabolism catabolism

7. Factors Regulating Insulin Secretion 1) High plasma glucose levels – insulin secreted to return glucose levels back to normal 2) High plasma amino acids – after a high protein meal, arginine and lysine stimulate beta cells to increase insulin secretion 3) Fatty acids and ketone bodies – increases secretion

8. Diabetes mellitus Type 1 – juvenile diabetes: Type 1 – juvenile diabetes: loss of insulin-producing beta cells leading to a deficiency of insulin loss of insulin-producing beta cells leading to a deficiency of insulin Type 2 – maturity onset: Type 2 – maturity onset: insulin resistance - cells fail to use insulin properly insulin resistance - cells fail to use insulin properly the most common type the most common type

9. Causes: heredity - stronger inheritance pattern for type 2 heredity - stronger inheritance pattern for type 2 type 1 appears to be triggered by some (mainly viral) infections (e.g. Coxackie virus) type 1 appears to be triggered by some (mainly viral) infections (e.g. Coxackie virus) obesity – type 2 obesity – type 2

10. Symptoms: 1) Polyuria (excess urine production) 2) Polydipsia (excess drinking of water) 3) Polyphagia (excessive eating) 4) Loss of weight 5) Asthenia (lack of energy)

11. Complications: Diabetic cardiomyopathy Diabetic cardiomyopathy Diabetic nephropathy Diabetic nephropathy Diabetic neuropathy Diabetic neuropathy Diabetic foot Diabetic foot Diabetic retinopathy Diabetic retinopathy

12. Treatment: Diabetes type I: Diabetes type I: artificial insulin – subcutaneous injection artificial insulin – subcutaneous injection insulin control, diet, weight control and exercise insulin control, diet, weight control and exercise

13. Diabetes type II: Diabetes type II: diet, weight loss diet, weight loss exercise to increase receptor responsiveness exercise to increase receptor responsiveness sulfonylureas to increase number of receptors sulfonylureas to increase number of receptors