Diabetes and the Pancreas
What is a Pancreas?
The pancreas is a long, soft organ that lies transversely along the posterior abdominal wall, posterior to the stomach, and extends from the region of the duodenum to the spleen. This gland has two major tissue types:
1.an exocrine portion (acini) that secretes digestive enzymes that are carried through a duct to the duodenum
2.an endocrine portion (islets of Langerhans) which consists of the pancreatic islets that secrete glucagons and insulin
Endocrine tissue contains alpha, beta, and delta cells. Alpha cells in the pancreatic islets secrete the hormone glucagons in response to a low concentration of glucose in the blood. Beta cells secrete the hormone insulin in response to a high concentration of glucose in the blood. Delta cells secrete the hormone somatostatin, which inhibits insulin and glucagon secretion.
How Does the Pancreas Relate to Diabetes?
Simply put, diabetes is the result of a deficiency of insulin, which is found in the endocrine tissue of the pancreas. In people with type 2 diabetes, the pancreas produces insulin but the body is not able to use it. Muscle, fat, and liver cells do not respond to insulin properly. This is a condition known as insulin resistance. People with insulin resistance need more insulin to help glucose enter the cells. The pancreas tries to keep up with the increased demand for insulin, but eventually fails to produce enough to do so. This causes excess glucose to build up in the bloodstream. Over time, the effects of repeated high blood glucose levels will damage beta cells, further reducing the ability of the pancreas to produce insulin.
Traditional treatment of diabetes includes the regulated use of insulin and/or oral medications, in addition to proper diet and exercise. There are also three procedures that can potentially treat diabetes:
1. Pancreatic islet transplant
2. Pancreas transplant
3. Artificial pancreas
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Occasionally my mailbox or follow-the-link browsing will come up with something discussing whether (and if so, when) to ease the restrictions on treatment goals when the patient is elderly, arguing either to favor a higher quality of remaining life (lifestyle choices less limited by chronic illness) or to take into consideration geriatric cognitive decline (aka "senility") and simplify, as much as possible, the regimen. While the goal of medicine is, obviously, not to...