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After reading this chapter, you should be able to:

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  • List the hormones that affect the plasma glucose concentration and briefly describe the action of each.
  • Describe the structure of the pancreatic islets and name the hormones secreted by each of the cell types in the islets.
  • Describe the structure of insulin and outline the steps involved in its biosynthesis and release into the bloodstream.
  • List the consequences of insulin deficiency and explain how each of these abnormalities is produced.
  • Describe insulin receptors, the way they mediate the effects of insulin, and the way they are regulated.
  • Describe the types of glucose transporters found in the body and the function of each.
  • List the major factors that affect the secretion of insulin.
  • Describe the structure of glucagon and other physiologically active peptides produced from its precursor.
  • List the physiologically significant effects of glucagon and the factors that regulate glucagon secretion.
  • Describe the physiologic effects of somatostatin in the pancreas.
  • Outline the mechanisms by which thyroid hormones, adrenal glucocorticoids, catecholamines, and growth hormone affect carbohydrate metabolism.
  • Understand the major differences between type 1 and type 2 diabetes.

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At least four polypeptides with regulatory activity are secreted by the islets of Langerhans in the pancreas. Two of these, insulin and glucagon, are hormones and have important functions in the regulation of the intermediary metabolism of carbohydrates, proteins, and fats. The third polypeptide, somatostatin, plays a role in the regulation of islet cell secretion, and the fourth, pancreatic polypeptide, is probably concerned primarily with the regulation of ion transport in the intestine. Glucagon, somatostatin, and possibly pancreatic polypeptide are also secreted by cells in the mucosa of the gastrointestinal tract.

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Insulin is anabolic, increasing the storage of glucose, fatty acids, and amino acids. Glucagon is catabolic, mobilizing glucose, fatty acids, and the amino acids from stores into the bloodstream. The two hormones are thus reciprocal in their overall action and are reciprocally secreted in most circumstances. Insulin excess causes hypoglycemia, which leads to convulsions and coma. Insulin deficiency, either absolute or relative, causes diabetes mellitus (chronic elevated blood glucose), a complex and debilitating disease that if untreated is eventually fatal. Glucagon deficiency can cause hypoglycemia, and glucagon excess makes diabetes worse. Excess pancreatic production of somatostatin causes hyperglycemia and other manifestations of diabetes.

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A variety of other hormones also have important roles in the regulation of carbohydrate metabolism.

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The islets of Langerhans (Figure 24–1) are ovoid, 76- × 175-μm collections of cells. The islets are scattered throughout the pancreas, although they are more plentiful in the tail than in the body and head. β-islets make up about 2% of the volume of the gland, whereas the exocrine portion of the pancreas (see Chapter 25) makes up 80%, and ducts and blood vessels make up the remainder. Humans have 1 to 2 million islets. Each has a copious blood supply; blood from the islets, ...

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