Pancreatic Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Pancreatic and links to relevant pages within the course.
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Diabetes is a metabolic disorder caused by impaired pancreatic function, resulting in decreased insulin concentration and activity. This causes the patient with diabetes to have elevated blood glucose concentrations (hyperglycemia). Hyperglycemia leads to serious risk factors and life-threatening complications for the individual. Because of these risks and the ensuing chronic illness for diabetic patients, ongoing medical care and education for self-management are required. Diabetes is a national and international healthcare issue due to its high incidence and healthcare costs. According to the World Health Organization (WHO) in 2000, there were 171 million individuals worldwide with diabetes. That number is projected to increase to 366 million by 2030.
|Blood Glucose and Hormonal Control|
Several hormones regulate blood glucose concentration. Insulin, the main regulatory hormone, is produced by and secreted from the pancreatic beta-cells. Insulin stimulates the uptake of glucose and the movement of glucose from blood to cells for energy production. Insulin also stimulates glycogenesis, inhibits glycogenolysis, and regulates protein synthesis.Other hormones that are also involved in carbohydrate metabolism include: Pancreatic glucagon- stimulates glycogenolysis and gluconeogenesis Adrenal gland cortisol- promotes gluconeogenesis Epinephrine- a neurotransmitter that increases glycogenolysis
|Type 1 Diabetes|
Type 1 diabetes is caused by an absolute deficiency of insulin from an autoimmune destruction of pancreatic beta cells or degeneration of these cells. The infiltration of mononuclear cells can be precipitated by environmental factors such as viruses, chemicals, and cow's milk or caused by unknown or idiopathic reactions. Ordinarily the individual has an inherited susceptibility to this autoimmune reaction and diabetes develops suddenly. Most often this onset occurs in childhood or young adult years. Type 1 diabetes encompasses about 10% of diabetes cases.Because of the beta-cell destruction, type 1 diabetic patients require insulin to prevent ketosis and reduce complications of this disease.This class was formerly Type I Insulin Dependent Diabetes Mellitus (IDDM) and referred to as juvenile-onset diabetes. The ADA has abolished using these designations but are noted in this review to correlate previously learned information with new recommendations.
|Insulin and C-Peptide|
Insulin is secreted by the pancreatic beta-cells as a prohormone composed of fragments: C-peptide and insulin. The C-peptide fraction is cleaved off the prohormone. The insulin fraction becomes active. C-peptide is inactive but provides structure to the prohormone and has a much longer half-life. Both of these hormones can be quantitated in blood.Insulin levels are not measured to diagnose or monitor diabetes but can give information about a patient and is an important assay in hypoglycemia. C-peptide is also measured in evaluating hypoglycemia and is used to distinguish between endogenous and exogenous insulin; it would be present in circulation in endogenous insulin secretion. It is also often used to monitor pancreatic surgery and transplant because of its longer half-life.
Since type 1 diabetes is caused by an autoimmune destruction of pancreatic tissue, sometimes antibody measurements are used to gain more information about a type 1 diabetic. Like insulin and C-peptide, insulin antibodies are not measured to diagnose or monitor a diabetic patient.
|The Laboratory's Role in Diagnosis and Monitoring of Diabetes|
Even though most diabetics, physician offices, clinics, nursing homes, and nursing units use glucose meters for monitoring glucose levels, the laboratory's role in diagnosis is vital. The function of the laboratory is crucial in diagnosis, monitoring, and management of diabetes. Diabetic patients can go into severe metabolic imbalances that are life threatening. These metabolic conditions include: diabetic ketoacidosis, hyperosmolar nonketotic coma, and hypoglycemia. Laboratory testing is essential in diagnosing and monitoring these conditions.Laboratory blood glucose and HbA1C levels are used to demonstrate the level of hyperglycemia required for diagnosis. If an OGTT is needed for classification or characterization of hyperglycemia, a patient is sent to a hospital or clinical laboratory for the test. Detection of elevated microalbumin levels that can signal early stages of renal impairment is accomplished through laboratory testing. There are many other disease states and complications associated with diabetes. Clinical laboratories detect these diseases and monitor the complications that result. Important among these assays are urea, creatinine, and serum lipids. If a diabetic does have a pancreatic transplant, serum C-peptide and insulins levels monitor transplant success and viability of transplanted organ.
Insulin is a pancreatic hormone that plays a vital role in carbohydrate and lipid metabolism. Insulin regulates glucose concentrations by: Promoting glycolysis - the uptake of glucose by cells for energy Stimulating glycogenesis - the conversion of excess blood glucose to glycogen storage in the liver Inhibiting glycogenolysis - the conversion of glycogen back to glucose Inhibiting gluconeogenesis - the formation of glucose from noncarbohydrates Insulin increases lipid synthesis in the liver and fat cells and inhibits lipolysis, the release of non-esterified fatty acids (NEFAs) from triglycerides in fat and muscle cells. Insulin also promotes protein synthesis.If insulin resistance occurs, carbohydrate and lipid metabolism are impaired. Insulin resistance ordinarily results in increased insulin levels as the body senses a need for more insulin action. The impaired insulin action results in elevated plasma glucose levels. The increase in lipolysis increases blood concentrations of NEFAs and causes abnormal blood lipid levels.