Pancreas

Pancreas is an elongated gland extending from the duodenum to the spleen; consist of a head,
body, and the tail. There is an exocrine portion, which secretes digestive enzymes that are carried by the
pancreatic duct to the duodenum, and pancreatic islet, which secrete insulin and glucagon.
The endocrine part of the pancreas consists of pancreatic islets (small islands; islet
of Langerhans) dispersed among the exocrine portion of the pancreas. The islets secrete two hormones
insulin and glucagonwhich function to help regulate blood nutrient levels, especially blood glucose.
Alpha cells of the pancreatic islets secrete glucagon. Beta cells of the pancreatic islet secrete
insulin.
It is very important to maintain blood glucose levels within a normal range of values. A decline in
the blood glucose levels within a normal range causes the nervous system to malfunction because
glucose is the nervous systems main source of energy. When blood glucose decreases, other tissues to
provide an alternative energy source break fats and proteins rapidly. As fats are broken down, the liver
to acidic ketones, which are release into the circulatory system, converts some of the fatty acids. When
blood glucose level are very low, the breakdown of fats can cause the release of enough fatty acid and
ketones to cause the pH of the fluids to decrease below normal, a condition called acidosis. The amino
acids of proteins are broken down and used to synthesize glucose by the liver.
If blood glucose levels are too high, the kidneys produce large volumes of urine containing
substantial amounts of glucose because of the rapid loss of water in the form of urine, dehydration
result.20
Insulin
Insulin is released from the beta cells primarily response to the elevated blood glucose levels
and increased parasympathetic stimulation that is associated with digestion of a meal. Increase blood
levels of certain amino acids also stimulates insulin secretion. Decreased result from decreasing blood
glucose levels and from stimulation by the sympathetic of the nervous system. Sympathetic stimulation
of the pancreas occurs during physical activity. Decreased insulin levels allow blood glucose to be
conserved to provide the brain with adequate glucose and to allow other tissues to metabolize fatty
acids and glycogen stored in the cell.
The major target tissues for insulin are the liver, adipose tissue, muscles, and the area of the
hypothalamus that controls appetite, called satiety center (fulfillment of hunger).Insulin binds to
membrane-bound receptor and, either directly or indirectly, increases the rate of glucose and
amino acid uptake in these tissues. Glucose is converted to glycogenor fat, and the amino acids used to
synthesize protein.
Glucagon

Glucagon is released from the alpha cell when blood glucose level is low. Glucagon binds to
membrane-bound receptors primarily in the liver and caused the conversion of glycogen storage in the
liver to glucose. The glucose is then released into the blood to increase blood glucose level. After a meal,
when blood glucose levels are elevated glucagon secretion is reduced.
Insulin and glucagon function together to regulate blood glucose levels. When blood glucose
increase, insulin secretion increases, and glucagon secretion decreases. When blood glucose levels
decrease, the rate of insulin secretion declines and the rate of glucagon secretion increase. Other
hormones, such as epinephrine, cortisol, and growth hormones, also function to maintain blood levels of
nutrients. When blood glucose level decrease, these hormones are secreted at a greater rate.
Epinephrine and cortisol caused the breakdown of protein and fat and the synthesis of glucose to
help increase blood levels of nutrients. Growth hormone slows protein breakdown and favors fat
breakdown
PATHOPHYSIOLOGY
Diabetes Mellitus Type 2 is referred to as non-insulin dependent diabetes mellitus(NIDDM).
In type 2 diabetes, can still produce insulin, but do so relatively inadequately for their body's needs,
beta cells are primary affected and there is a poor production of insulin. Insulin is also the principal
control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells.
Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the
reverse conversion of glycogen to glucose when glucose levels fall. If the insulin is deficient the
intracellular and the intravascular space are affected. In the intracellular space there is a failure of
glucose to enter in the intracellular space because there is a lack of insulin and insulin acts as the key to
be able the glucose to enter in the cell. And when this happened the glucose supposed to be absorb by
the cells are staying in the blood and this term is hyperglycemia. If cell was not able to absorb the sugar
there will be intracellular and extracellular dehydration and body will compensate and the person will
have the urge to drink more water it is term polydipsia. Also if cell has no glucose intake there will be
cellular starvation and the person will have the urge to eat and eat and it is termed polyphagia. In the
intravascular area if the insulin is insufficient and glucose are not absorb by the cell the glucose is
staying in the blood stream and the glucose level in the blood will increase as the sugar in blood increase
the blood circulation will become viscose. Prolonged high blood glucose level leads to sluggish
circulation and when the glucose concentration in the blood is raised beyond its renal
threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose
remains in the urine(glycosuria). This increases the pressure of the urine and inhibits reabsorption of
water by the kidney, resulting in increased urine production ( polyuria) and increased fluid loss. Lost
blood volume will be replaced osmotically from water held in body cells and other body compartments,
causing dehydration and increased thirst.

Non-modifiable

Modifiable

Diet

Hereditary

Stress

Age

Poor production of Beta cells

Insulin Deficiency

Intracellular: failure of glucose to

enter in ICS

Intravascular: increase
glucose in blood

Hypergylcemia

Systemic blood Viscosity

ECF/ICF dehydration

Polydipsia

Cellular starvation

Increase Osmotic pressure

in renal tubules

Polyphagia
Polyuria