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Anatomy and Physiology
Anatomy and Physiology
Every cell in the human body needs energy in order to function. The
bodys primary energy source is glucose, a simple sugar resulting from the
digestion of foods containing carbohydrates (sugars and starches). Glucose from
the digested food circulates in the blood as a ready energy source for any cells
that need it. Insulin is a hormone or chemical produced by cells in the pancreas,
an organ located behind the stomach. Insulin bonds to a receptor site on the
outside of cell and acts like a key to open a doorway into the cell through which
glucose can enter. Some of the glucose can be converted to concentrated energy
sources like glycogen or fatty acids and saved for later use. When there is not
enough insulin produced or when the doorway no longer recognizes the insulin
key, glucose stays in the blood rather entering the cells.
Digestive System
The functions of the digestive system are:
The digestive system also builds and replaces cells and tissues that are
constantly dying.
Digestive Organs
The digestive system is a group of organs (Buccal cavity (mouth),
pharynx, oesophagus, stomach, liver, gall bladder, jejunum, ileum and colon) that
breakdown the chemical components of food, with digestive juices, into tiny
nutrients which can be absorbed to generate energy for the body.
The Pharynx
Situated at the back of the nose and oral cavity receives the softened food
mass or bolus by the tongue pushing it against the palate which initiates the
swallowing action.
At the same time a small flap called the epiglottis moves over the trachea
to prevent any food particles getting into the windpipe.
From the pharynx onwards the alimentary canal is a simple tube starting
with the salivary glands.
The Esophagus
The esophagus travels through the neck and thorax, behind the trachea
and in front of the aorta. The food is moved by rhythmical muscular contractions
known as peristalsis (wave-like motions) caused by contractions in longitudinal
and circular bands of muscle. Antiperistalsis, where the contractions travel
upwards, is the reflex action of vomiting and is usually aided by the contraction of
the abdominal muscles and diaphragm.
The Stomach
The stomach lies below the diaphragm and to the left of the liver. It is the
widest part of the alimentary canal and acts as a reservoir for the food where it
may remain for between 2 and 6 hours. Here the food is churned over and mixed
with various hormones, enzymes including pepsinogen, which begins the
digestion of protein, hydrochloric acid, and other chemicals; all of which are also
secreted further down the digestive tract.
The stomach has an average capacity of 1 litre, varies in shape, and is
capable of considerable distension. When expanding this sends stimuli to the
hypothalamus which is the part of the brain and nervous system controlling
hunger and the desire to eat.
The wall of the stomach is impermeable to most substances, although
does absorb some water, electrolytes, certain drugs, and alcohol. At regular
intervals a circular muscle at the lower end of the stomach, the pylorus opens
allowing small amounts of food, now known as chyme to enter the small
intestine.
The Liver
The liver, which acts as a large reservoir and filter for blood, occupies the upper
right portion of abdomen and has several important functions:
Storage of vitamins
Phagocytosis - ingestion of worn out red and white blood cells, and
some bacteria
To release insulin directly into the blood stream for the purpose of
controlling blood sugar levels.
Insulin is a familiar word as there are many who suffer from diabetes. But
most of us might not have heard of glucagons, which is very much an important
substance for our body. The importance of insulin and glucagon are due to their
action in maintaining the balance of blood glucose levels in our body. Glucose is
a very important element for our body. We need energy for our bodily activities.
This energy is derived from glucose. Glucose is the body's primary source of fuel.
Whatever food we consume that is transformed into glucose in our body. This
glucose is than transported to our body cells by blood to be used as energy
source. So without glucose our body will be out of energy source leading to a
shutting down of all activities. When we work hard or have not taken meal for
long time we feel hungry. This hunger is the state when our body runs short in
glucose and needs immediate refueling. In this circumstances when we take
food, the food gives supply of glucose and our body glucose comes to a stable
situation leading towards the smooth functioning of the body.
Role of Insulin:
When we take food and glucose is made from the food metabolism, this
glucose is than transported to our body cells by blood to be used as energy
source. In this phase we need a hormone named Insulin which assists the
glucose in the blood to enter in the cells. When blood glucose levels rise, cells
named beta cells in pancreas release insulin. Pancreas is an organ located
behind our stomach. Without the presence of insulin our body cells cannot take
up the glucose from the blood leading to glucose crisis in the body cells for
performing activities. If we insulin deficit, the process of glucose metabolism
begins working improperly. Instead of being transported into body cells, glucose
starts building up in the bloodstream. This situation may occur in two conditions.
1) When body cells become resistant to the action of insulin. Exactly why
the cells become resistant to insulin's effects is still not clearly known.
2) If there is deficit in glucose production in the body by the glucose
producing cells in pancreas.
These two situations can lead towards the disease condition called
diabetes mellitus.
Role of Glucagon
When there is accesses glucose in our body, this glucose is stored for
future use by out body as fat cells. If in any case there is any shortage of glucose
in our body and there is no supply available than body goes for the alternative
way to fulfill the deficit. When blood glucose levels fall, cells named alpha cells in
pancreas release glucagon. When blood glucose is high, no glucagon is secreted
from the alpha cells. Glucagon has the greatest effect on the liver although it
affects many different cells in the body. When glucose levels are low our liver
releases the stored glucose into the bloodstream to keep blood glucose level
within a normal range and Glucagon's main function is to cause the liver to
release stored glucose from its cells into the blood.
Glucose level: insulin and glucagon
Our body requires that the blood glucose level is maintained in a very
narrow optimal range. Our body tries to maintain the blood glucose normally
between 70 mg/dl and 110 mg/dl. Blood glucose levels below 70mg/dl, is called
"hypoglycemia". A blood glucose level of 180mg/dl or more is called
"hyperglycemia". If the blood glucose is lower than optimal then our body tries to
bring it up to the optimal level. Similarly if the body glucose level is higher than
the optimal level then our body tries to bring it down to the optimal level. So
according to the body glucose level, body decides which one to secrete, insulin
or glucagon? After a meal, the amount of insulin secreted into the blood
increases as the blood glucose rises. Similarly, as blood glucose falls, insulin
secretion by the pancreatic islet beta cells decreases. On the other hand,
glucagon is secreted by the alpha cells of the pancreas when blood glucose is
low. As for example, blood glucose is low between meals and during exercise. So
for compensating the need of the body the glucoagon is secreted. Contrary to
that, when blood glucose is high, no glucagon is secreted from the alpha cells.
So we see that the insulin and glucagon secretion is coordinated. Consumption
of carbohydrates triggers release of insulin from beta cells.
Alpha cells become inhibited and cease to secrete glucagon. Opposite
happens when we have enough glucose supplied to the body. Major control of
blood glucose levels is achieved through actions of the hormones insulin and
glucagon. The slightest rise in plasma glucose leads to a decrease in glucagon
secretion and an increase in insulin secretion. The reverse occurs when plasma
glucose levels fall. Maintaining this balance is very important for our body and
any situation leading to the imbalance create disease condition.
Weight loss due to wasting of lean body mass secondary to fat and
protein metabolism.
Complications
Acute Complications
Chronic Complications
Macrovascular Complications
Microvascular Complications
Neuropathy nerve fibers do not have their own blood supply instead
rely on diffusion of oxygen and nutrients. If they are not nourished,
their transmission of impulse slows.
Risk Factors
Predisposing or Non Modifiable Factors
Sex
Lack of exercise
Obesity/Sedentary Lifestyle
Stress
Advise patient to assess blood glucose level before strenuous activity and
to eat carbohydrate snack before exercising to avoid hypoglycemia.
Assess feet and legs for skin temperature, sensation, soft tissues injuries,
corns, calluses, dryness, hair distribution, pulses and deep tendon
reflexes.