 Congenital

◦ PKU
◦ Galactosemia
 After Birth
◦ Diabetes Mellitus
Histologically, two separate components
 Exocrine Pancreas: 80-85 % of organ
 Endocrine Pancreas:
◦ About 1 million cellular units; the islets of
Langerhans and a few scattered in ducts
◦ 1 – 1.5 gm
◦ Most measure 100 to 200 micrometer
◦ Four major and two minor cell types
 Four Major
◦ Beta (70%) ----- Insulin
◦ Alpha (20%) --- Glucagon
◦ Delta (5-10 %) -- Somatostatin
◦ Pancreatic polypeptide (1 to 2 %) – PP molecule
 Two rare Cells
◦ D1 cells (Vasoactive intestinal polypeptide)
 Glycogenolysis
 Hyperglycemia
 Gastro intestinal fluid secretion
◦ Enterochromaffin cells
 Serotonin
A source of pancreatic tumors --- induce carcinoid
tumors
 A group of metabolic disorder
 Impaired glucose utilization
 Induce hyperglycemia
 Defective or deficient insulin secretory
response
 Glucose uderutilization
 Fat and Protein metabolisms are also effected
 Primary
◦ IDDM
◦ NIDDM
 Non obese NIDDM
 Obese NIDDM
 Maturity – onset diabetes of the young
 Secondary
◦ Chronic pancreatitis
◦ Postpancreatectomy
◦ Hormonal tumors
◦ Drug, Hemachromatosis, Genetic disorders
 Tightly regulated by three inter related
processes:
◦ Glucose production in the liver
◦ Uptake and utilization of glucose by peripheral
tissues
◦ Insulin secretion

Insulin secretion is modulated such that glucose

production and utilization rise or fall to maintain
normal blood glucose levels
 Insulin gene expression
 Beta cells of pancreatic islets
 Mature insulin mRNA is transcribed
 Translation occurs in rough endoplasmic
reticulum ---- preproinsulin
 Proteolytic cleavage of prepeptide sequence
to yield proinsulin
 Cleavage of C-peptide to yield insulin in
Golgi apparatus
 Insulin and C-peptide are stored in secretory
granules
 Secreted together after physiologic
stimulation
 Release of insulin from beta cells is a biphasic
process involving two pools of insulin
 A rise in blood glucose level results in
glucose uptake into beta cells
 Insulin independent glucose transporting
protein GLUT-2
 Glucose uptake by beta cells results in
immediate release of insulin that is already
stored in beta cells
 If secretory stimulus persists, a delayed and
protracted response follows
 Active synthesis of insulin

 “most important stimulus that triggers insulin

release and initiates insulin synthesis; is
glucose”. Although there are some others also.
 A major anabolic hormone necessary for
◦ Transmembrane transport of glucose and amino
acids
◦ Glycogen formation in the liver and skeletal
muscles
◦ Glucose conversion to triglycerides
◦ Nucleic acid synthesis
◦ Protein synthesis
“its prime metabolic function is to increase the rate
of glucose transport into certain cells of the body e.g.
striated muscles”
 Insulin interacts with target cells by first
binding to the insulin receptor, two
glycoprotein subunits α and β.
 Amount of insulin bound to cells is affected
by
◦ Availability of receptors
◦ Their numbers
◦ Their function
 Receptor bound insulin triggers a number of
i/c responses
◦ Activation or inhibition of insulin sensitive enzymes
◦ Protein synthesis
◦ DNA synthesis

Translocation of glucose transport protein units

(GLUTs) from Golgi apparatus to plasma membrane
GLUT-4 (Muscle and adipose tissue)
GLUT-2 (Liver and beta cells of pancras)
 Glucose is the Primary Source of Energy for
Cells
 Glucose ---is the human body's key source
of energy as it provides energy to all the cells
in our body.
 Glucose also is critical in the production of
proteins, lipid metabolism and is a precursor
for vitamin C production.
 Glucose is the sole source of fuel to create
energy for all brain and red blood cells. The
availability of glucose influences many
psychological processes. When glucose levels
are low, psychological processes requiring
mental effort l(self-control, critical thinking
and decision-making) become impaired.
 The human body converts carbohydrates,
particularly glucose, into glycogen for
storage, mainly in liver and muscle cells for
daily use and in adipose cells and tissues as
body fat for long term energy use.
 Glucose is mostly found in food as a building
block in more complex carbohydrates.
Complex carbohydrates are composed of
thousands of glucose units linked together in
chains. Our digestive system breaks down
complex carbohydrates into many molecules
of glucose for use by our cells to create
energy.
 The majority of our carbohydrates intake
should come from complex carbohydrates
(starches) and naturally occurring sugars,
rather than processed or refined sugars,
which do not have the vitamins, minerals, and
fiber found in complex and natural
carbohydrates.
 Refined sugars like high-fructose corn syrup
are often called "empty calories" because they
have little to no nutritional value. High-
fructose corn syrup is not to be confused with
corn syrup, which has a high glucose content.
 Diabetes is a disease that affects your body's
ability to use glucose due to the body's
inability to sufficiently make or process
insulin. The hormone insulin, which is
secreted by the pancreas gland, moves
glucose from the blood and funnels it into the
cells so it can be used as fuel. If the cells are
unable to get adequate amounts of glucose,
they can literally starve to death. As they do,
tissues and organs begin to degenerate.
 what happens in diabetes. Diabetes is caused
by a problem in the way your body makes or
uses insulin. Insulin is needed to move
glucose in our blood into cells, where it is
stored and later used for energy. When
glucose cannot enter cells, high levels of this
sugar build up in the blood. This is called
hyperglycemia.
 There are primarily two types of Diabetes.
Type 1 Diabetes or insulin-dependent
diabetes is usually occurs young in life. With
Type 1 Diabetes, the beta cells of the
pancreas no longer make insulin because the
body's immune system has attacked and
destroyed them. Treatment for type 1
diabetes includes taking insulin frequently.
 Type 2 Diabetes usually begins with insulin
resistance, a condition in which fat, muscle,
and liver cells do not use insulin properly. As
a result, blood glucose does not get into
these cells to be stored for energy and
remains in the blood stream. At first, the
pancreas keeps up with the added demand by
producing more insulin. In time, however, the
pancreas loses the ability to secrete enough
insulin to process glucose into our cells.
 Diets containing foods with high-frucose
corn syrup contribute to the development of
Type 2 Diabetes
 1. Pasta is rich in complex carbohydrates.
 2. Whole Grain Bread made without high-fructose
corn syrup are nutritious sources of complex
carbohydrates.
 3. Whole Grains and Whole Grain Cereals made
without high-fructose corn syrup are also
nutritious sources of complex carbohydrates. See
Health Benefits of Whole Grains - Nutrient
Comparison between Whole Grains and Refined
Flour Products
 4. Legumes which includes beans, lentils and peas are high
sources of complex carbohydrates and also contain protein.
 5. Potatoes are high in starch (long chain glucose molecules) and
also contain iron, potassium, phosphorus, Vitamin C and
magnesium.
 Complex carbs keep us satisfied for longer time than foods
containing simple sugars/high-fructose corn syrup.
Consumption of complex carbohydrates requires less food intake
and this results in less caloric intake. That is why complex carbs
are suggested in weight maintenance diets.
 6. Dairy products including milk, yogurt and cottage cheese all
contain lactose. Lactose is composed of one glucose molecule
joins a galactose molecule, which is digested into glucose. Raw
Milk is your best natural food source for glucose - Read why
here!
 7. Vegetables contain glucose often in the form
of starch.
◦ Vegetable high in starch include, corn, squash and
zucchini.
◦ Low starch vegetables include eggplant, mushrooms,
cabbage, cauliflower, celery, cucumbers, okra, green
beans, red and green peppers, onions, and tomatoes,
and are all packed with nutrition.
 8. Grapes are an especially rich source of
glucose.
 9. Honey contains about 38% glucose.
 Diabetes is a metabolic disease that affects
your body's ability to use glucose.
 Glucose is a simple sugar that provides
energy to all of the cells in your body.
 The cells take in glucose from the blood and
break it down for energy.
 Brain cells and red blood cells, rely solely on
glucose for fuel. The glucose in your blood
comes from the food that you eat
 Hyperglycemia leads to
 a. Polyuria (hyperglycemia acts as osmotic
diuretic)
 b. Glycosuria (renal threshold for glucose: 180
mg/dL)
 c. Polydipsia (thirst from dehydration from
polyuria)
 d. Polyphagia (hunger and eats more since cell
cannot utilize glucose)
 e. Weight loss (body breaking down fat and
protein to restore energy source
 f. Malaise and fatigue (from decrease in energy)
 g. Blurred vision (swelling of lenses from osmotic
effects)
 Eye Retina. Damage to the eye retina from
diabetes is a leading cause of blindness.
 Kidney Failure. Damage to the kidneys from
diabetes is a leading cause of kidney failure.
 Nerve Damage. Damage to the nerves from
diabetes is a leading cause of foot wounds
and ulcers, which frequently lead to foot and
leg amputations
 Damage to Autonomic Nervous System. Damage
to the nerves in the autonomic nervous system
can lead to paralysis of the stomach, chronic
diarrhea, and an inability to control heart rate
and blood pressure during postural changes.
 Diminished Mental Capacity. As glucose is the
sole source of fuel for brain cells, there is
growing and logical evidence that Dementia and
Alzheimers may be cuased by Pre-Diabetes and
Diabetes.
 Damage to Cardio Vascular System. Diabetes
predisposes people to high blood pressure
and poor circulation.
 Impaired Immune System. Many infections
are associated with diabetes, and infections
are frequently more dangerous in someone
with diabetes because the body's normal
ability to fight infections is impaired.
 Skin Infections. People with Diabetes are
more likely to get skin infections caused by
fungus and bacteria. This is because some
fungus and bacteria feed off glucose. Also,
high blood glucose levels make the body's
natural defenses less effective.
 Diagnosis
◦ Patient is symptomatic plus
 Casual plasma glucose (non-fasting) is 200 mg/dl OR
 Fasting plasma glucose of 126 mg/dl or higher OR
 Two hour plasma glucose level of 200 mg/dl or
greater during an oral glucose tolerance test
 Oral glucose tolerance test
◦ 75 gm glucose in 100 ml water
◦ Sampling after every 30 minutes
 HbAIc test
◦ Whole blood
◦ Gives clue for blood glucose for last 3 months