Causes Of Diabetes Mellitus Among Cocin Clergies And Its Effects

CAUSES OF DIABETES MELLITUS AMONG COCIN CLERGIES AND ITS EFFECTS: CASE STUDY OF COCIN PCC JOS

AN OVERVIEW OF THE PANCREATIC SYSTEM

1. Diabetes mellitus is a condition resulting from insulin deficiency. A disorder that develops when the cells of the body do not receive enough     insulin
2. Diabetes Insipitus is a condition that is characterised by excessive thirst and the passing of large quantities of diluted urine.

Types of Diabetes Mellitus

Diabetes mellitus is a condition resulting from insulin deficiency, it disturbs carbohydrate, protein and fat metabolism. We have 2 common types of diabetes mellitus:

1. Insulin dependent diabetes mellitus (IDDM). Also called Type I, as well as Juvenile diabetes mellitus.
2. Non-Insulin dependent diabetes mellitus. (NIDDM)

Also called Type II, as well as dependent onset diabetes mellitus, before discussing about diabetes mellitus we will first look at the

• Related Anatomy and Physiology of the Pancreases.
• The Pancreatic Duct.
• The conducting system of the pancreas.
• Blood Vessels and Nerve supply of the pancreas.
• Factors maintaining glucose level
• Factors affecting blood glucose level

2.2     THE PANCREASE

The pancreas is an accessory digestive organ that produces and aids the duodenum produce or empty duodenal secretions that come from the accessory digestive organs.

Enzyme/Secretion. Digestive Action

Amylase – Pancrease Enzyme source – starch – dextrine

Action of Enzyme

Tripsin – Pancreas – proteins, polypeptides – polypeptids dipetides amino acid

Pancreatin lipase –pancras – Thglycehides, faty aicds, diglycend monoglycendes.

Substances

Cholecystokini – Fat in duodemun

Pancrease – Increased production of enzyme rich pancreatic secretion

Secretin – PH of chyme in duodenum below 4 – 5 pancreas increase products of bicarborate rich pancreatic juice.

Pancreatic secretions have an alkaline PH due to their high concentration of bi-carbonate. They aid in neutralizing the acid entering the duodenum from the stomach.

The digestive enzymes, secreted by the pancrease include trypsin which aids in digesting protein, Amylased which aids in digesting starch/and lipase which aids in digesting fats. These secretions drain into the pancreatic duct, which empties into the common bile duct at the ampulla of vater.

The sphincter of oddi found at the confluences of the common bile duct and duodenum controls the flow of bile. Hormones, neuroregulators and local regulations found in these intestinal secretions control the rate of intestinal secretions and also influence Gastro Intestinal mobility. Pancreatic juice 1 litre per day is produce in the digestive system.

Food is ingested in form of fats, protein and carbohydrate and is broken down into absorbable particles by the process of digestion.

Carbohydrate are broken down into disaccharide e.g (glucose, fructose) and monosacaride e.g (glucose, fructose). Glucose is the major carbohydrate that tissue cells use as fuel. Small finger – like projections called villi are present throughout the entire intestine and function to produce digestive enzymes as well as to absorb Nutrient.

Certain amount of glucose circulates in the blood. The major sources of this glucose are: absorption of ingested food in the gastrointestinal tract and formation of glucose by the Liver cells from food substances.

Pancreatic secretion into the intestine is regulated mainly by hormones secreted by the intestinal mucosa.

The entrance of the acid solution chime into the duodenum causes the release of secretin (Prosecretin) into the blood when secretin reaches the pancreas, it activates the cells to secrete a fluid high in sodium bicarbonate. Failure to produce this alkaline solution may result in damage to the duodenum by the chime, which is strongly acid and contains pepsin. The duodenal mucosa is not as well protected by mucus as the gastric mucosa. Cholecystokinin-pancreozymin (CCK) is produce by the duodenal mucosa when food enters from the stomach.

It is carried to the pancreas where it causes the cells to produce a thicker solution rich in enzymes, Cholecystokinin-pancreozymin produces contractions of the gall bladder and enhances the action of secretin stimulating the alkaline pancreatic fluid. Secretion of Cholecystokinin-pancreozymin by the duodenal mucosa is stimulated by the presence of fatty acids and amino acids in the chyme.

Some control of pancreatic secretion is also exerted via the vagus nerve a local peptidergic Nerve. Sensory Impulses are initiated by food in the stomach and result in vagal stimulation of the pancreatic cells to produce enzymes. Hormones secretion excites the pancreas and causes increase in out put of bile Fat soluble vitamins A, D, E, and K are absorbed from the small intestine if bile salts and pancreatic lipase are present.

The gall bladders, bile ducts, cystic duct leading from the gall merges with the hepatic duct to form the ampulla of vater which opens into the duodenum. This opening is controlled by the sphinter of oddi. The functions of the gall bladder are to concentrate and store the bile when the stomach and duodenum contracted the bile that is continuously secreted accumulates in the gall bladder.

Contraction of the sac to eject the bile is dependent upon hormonal stimulation, when food containing fat and partial digested protein enters the duodenum a hormone called cholecystokinin – Pancreozymin (CCK-PZ OR CCK) is secreted by cells of the duodenal mucosa. It is carried in the blood and oil reaching the gallbladder stimulates the smooth muscles tissue to contract and eject bile. CCK also produces relation of the sphinter of oddi which allows the flow of bile into the duodenum. The pancreatic juice enters the duodenum as the ampulla of vater and consists of water, mineral salts, enzymes, trypsinogen, chymotrypsinogen, amylase, lipase. Pancreatic juice is strongly alkaline (PH 8) when acid stomach contents (PH 1 to 3) enter the duodenum they are mixed with pancreatic juice and bile and the PH is raised to between 6 and 7. This is the PH at which the pancreatic enzymes act most effectively.

Functions of Pancreas  

1. Pancreas produces trypsinogen and chymorypsine in active enzymes until they come in contact with enteropeptidase (Enterokinase) and Enzyme in        intestinal juice, which converts them into trypsin and chymotrypsin.

These enzymes convert peptones into peptides and polypeptides. It is important precursors of protein splitting enzymes otherwise they would digest the pancreas.

2. Secretions – secretion of pancreatic juice is stimulated by two hormones secretin and cholecystokinin-pancreozymin (CCK-PZ) produced by cells in the walls of the small intestine.

The presence of secretin in the duodenum in the stomach stimulates the production of these hormones. Amylase acts with pancreatic amylase in converting polysaccharides.

• Production of Endocrine hormones
• Production of Exocrine hormones
• Endocrine – Production of Insulin
• Glucagons
• Somastostatin

Pancreatic polypeptides

Pancrease –  B cells – Produce Insulin

Alpha cells – produce – glucagons

Function of Delta cells – somastatin of Glucagon

1. Increase blood glucose concentration by breaking down liver glycogen and increase the synthesis of glucose by the liver.
2. Promote break down of fatty acids and glycerol and release of potassium from the liver.

2.3     FACTORS THAT MAINTAIN THE RELEASE OF GLUCAGONS INTO THE BLOOD STREAM

1. Physical Exercise
3. Sympathetic Nervous system.

Components of Pancreatic Juice

1. Water
2. Mineral Salts
3. Enzymes,trpsinogen
4. Chymotrpsinogen
5. Amylase
6. Lipase

Production of pancreatic hormones   

The exocrine cells secrete digestive enzymes into all network of ducts that meet to form the main pancreatic duct which carries bile from the gall Bladder to form a small chamber the ampulla of vater. Which opens into the duodenum. Also secreted is sodium Bicarbonate. Which neutralizes stomach acid entering the duodenum.

The Endocrine cells (The Islets of Langerhan), are surrounded by many blood Vessels, into which they secrete the hormones insulin, glucagons and Somastatin. These hormones regulate the level of glucose in the blood. serious disruption of pancreatic function occurs only when the secretory tissue of the gland has been damaged or destroyed in advanced disease.

The common pancreatic disorder is diabetes mellitus. In which insulin-producing cells in the gland are destroyed.

Structure

The pancreas weighs about 60 grams, it is about 12 to 15 cm long. It consists of a large number of lobules made up of small alveoli the walls of which consist of secretory cells. Each lobule is drained by a tiny duct and these unite to form larger and larger ducts until they form the Pancreatic duct. This duct extends the whole length of the gland and opens into the duodenum at its midpoint. Just before entering the duodenum the pancreatic duct joins the bile duct to form the ampullla of the bile duct. The Duodenal opening of the ampulla is controlled by the splinter of oddi.

Isles of langerhans are cells in a cluster distributed throughout the substances of the pancreas, there are little collections of a different type of cell. These cells form what are known as the Islets of langerhans. Their secretion passes directly into the (Pancreatic veins) circulating blood and consists of the hormones insulin and glucagons

The alveoli of the pancreas produce pancreatic juice, which plays important part in the chemical digestion of food.