The Pancreas and Diabetes (Pirates of the Pancreas)

Ahoy Mateys!

In this post, we’ll be experiencing a wild adventure with the Pirates of the Pancreas, over the islets of Langerhans, to find the treasure maps and cannons vital to one’s existence.

In short, think of this post as an exploration of your pancreas, its essential parts, and its role in the development of diabetes.

Jump to Sections

1. Glucagon and Insulin
2. Transforming Sugar into Energy
3. Hypoglycemia vs Hyperglycemia
4. The Three P’s of Hyperglycemia
5. Types of Diabetes

Pirates of the Pancreas: The Adventure Begins

We’ll be associating this lecture with a pirate adventure to make it easier for us to explain and easier for you to remember each structure’s purpose and responsibility.

This portion is called “Pirates of the Pancreas,” primarily because the pancreas is shaped like a small island. When discussed, it’s like taking a quick adventure to discover its different essential components. So expect terms like treasure maps, volcanoes, cannons, and their medical term counterparts that are entirely intertwined with the pancreas.

Islets of Langerhans: The Volcanoes

So, you ask, “Why are islets of Langerhans compared to volcanoes?” It’s because the islets of Langerhans look like small volcanoes from an overhead perspective. Islets of Langerhans shoot out essential hormones.

Points to remember about the islets of Langerhans

1. Beta cells, the ones responsible for producing insulin, are located in the islets of Langerhans.
2. Glucagon, the hormone that takes out stored glycogen from the liver, can also be seen in the islets of Langerhans.

Enzymes: The Cannons

The actual tissue of the pancreas, or the island itself, creates the enzymes or what we refer to as the cannons of our pirates. What do cannons do? They go ba-boom! With that in mind, the enzymes (cannons) that break down protein, lipids, and carbohydrates are the following:

• Protein – Protease
• Lipids – Lipase
• Carbohydrates – Amylase

Additional information:

Amylase is also present in human saliva, so carbohydrate metabolism and breakdown initially happen inside the mouth. But, the majority of where carbohydrate gets broken down is inside the gastrointestinal tract, specifically in the pancreas.

Food Digestion

Here’s a quick overview of how people use their food and what normally happens inside the body when nutrients and minerals are introduced.

So, when a person eats something, it goes inside the stomach. Once the pancreas recognizes the introduction of food, it will release enzymes to digest whatever was ingested, whether it’s protein, fats or carbohydrates, or a combination of all three.

The enzymes metabolize and break down the protein, lipids, and carbohydrates to aid in the proper digestion of food by the body, which initially happens initially inside the duodenum. The duodenum is the first part of the small intestine and is situated right after the stomach.

Diagnosing Pancreatic Problems

The pancreas is near the liver and the gallbladder, so technically, there is a lot of action regarding digestive interaction. Therefore, if a client comes in complaining about abdominal pain, diagnostic studies will be done to determine the main organ affected.

For example, when diagnosing pancreatitis, enzymes– protease, lipase, and amylase – are usually involved and are the basis for diagnosing any abnormalities.

Glucagon and Insulin: Hormones of the Islets of Langerhans

Glucagon and insulin are two hormones secreted by the volcanoes (islets of Langerhans). Glucagon and insulin are essential in maintaining normal blood sugar levels. 

These two hormones are also referred to as the counter-regulatory hormones, meaning they are the on-and-off switch for specific elements inside the body. In this case, it would be switched to facilitate blood glucose.

Insulin vs Glucagon

Insulin acts like a key. It’s the hormone responsible for “opening up” the cell to allow sugar to come through and be converted into energy. From the bloodstream, insulin takes sugar and takes it inside the cell. This mechanism helps to decrease blood sugar levels in the bloodstream.

Unlike insulin which decreases sugar in the bloodstream, glucagon, on the other hand, increases the sugar level in the bloodstream by breaking down glycogen. Glucagon is useful when people require an increased amount of sugar, more than their body’s usual utilization, specifically those who are actively involved in any type of sports like marathons.

Glycogen Wall: The Stored Treasure

What does glucagon break down? It’s the stored treasure called glucose. Glucose gets stored in the body and is used when necessary, during rainy days, or when the body needs more supply of sugar in the bloodstream. 

Athletes or persons involved in sports or outdoor activities carb-load the day before the event. Carb-loading is consuming a large amount of carbohydrates so that the body would have an ample amount of stored glucose on the day of the event.

Most of the stored sugar in the body is deposited as fat. However, the first phase of the body storing sugar is when it creates a glycogen wall. A glycogen wall is composed of glucose bricks. The process of building the glycogen wall is termed as “glycogenesis” while the breaking down of the wall is called “glycogenolysis.”

Take note that “genesis” in the Bible means the creation. On the other hand, “-lysis” technically means to break something down, which, in this case, is the glycogen wall.

Remember:

• Glycogenesis – build a wall
• Glycogenolysis – break a wall

Transforming Sugar into Energy

As previously mentioned, insulin serves as the key that lets glucose enter the cell. Once insulin has done its job (letting glucose into the cell) the cell transforms the glucose into energy, and the body uses it for its daily activities. In this case, glucose serves as the body’s fuel.

Cells create energy by breaking down glucose into two pyruvates. Pyruvates go through the citric acid or Krebs cycles to pump out little carbon bonds to create adenosine triphosphate (ATP). This cycle is possible with the presence of oxygen, also known as aerobic metabolism.

Without Oxygen

Let’s imagine a person is running a marathon, and the body is utilizing glucose to fuel the system. The body will break down the pyruvates, but insufficient oxygen is available to sustain the requirement. The body will then go into anaerobic metabolism. Without oxygen to facilitate the creation of ATP in the body, lactic acid will take its place.

Clients with high levels of lactate acid in the body would most likely interpret that lactic acid was used instead of oxygen to create energy.

How would you know if your body uses oxygen or lactic acid when creating energy?

The body will experience soreness after strenuous activity. Which is why, it’s necessary to observe moderation when engaging in sports or fitness activities during the first month of exposure or training because the lungs need to adjust and expand to accommodate enough oxygen.

The body gets sore because lactic acid burns the muscles. To prevent this from happening, more oxygen is required. Hydration is essential to alleviate the soreness. The key is adequate hydration.

Fat as Fuel

The body’s primary fuel is glucose. Fat, on the other hand, can be considered the secondary fuel, which is more like diesel. If the body uses fat as its fuel, the system will have increased ketones. 

The popular “Atkins diet” is a typical example of the body using fat as its primary fuel because the diet insists on ingesting low carbohydrates and increased protein. Therefore, the body will utilize fat as its primary fuel, and increased ketones will become apparent in the urine.

One of the major disadvantages of using fat as fuel is that a high protein, low carbohydrate diet can lead to hyperuricemia and hypercalciuria. This can lead to gout, joint pain, kidney stones, and osteoporosis.  

Hypoglycemia vs Hyperglycemia

Understanding the differences between hypoglycemia and hyperglycemia is crucial for nursing students in providing optimal care to patients with diabetes. 

Hypoglycemia refers to low blood glucose levels, typically below 70 mg/dL, and is characterized by symptoms such as shakiness, confusion, sweating, and dizziness. Immediate interventions involve administering a fast-acting source of glucose to raise blood sugar levels. 

On the other hand, hyperglycemia indicates high blood glucose levels, usually above 180 mg/dL, and is marked by increased thirst, frequent urination, fatigue, and blurred vision. Management strategies for hyperglycemia involve insulin administration, fluid replacement, and addressing the underlying causes. 

By comprehending the distinctions between these two conditions, nursing students can effectively recognize and respond to hypo- and hyperglycemic episodes, promoting optimal client outcomes.

Hypoglycemia

There will be moments wherein the body will become hypoglycemic. Hypoglycemia (or the state of having low blood sugar), is a normal occurrence. This is especially true if you’ve missed a meal or didn’t get enough sugar to sustain your activities that require more energy.

The normal blood sugar is between 70 to 105 mg/dl. If the body’s blood sugar goes below that normal range, that’s the time that the acronym HIWASH comes in. For those who are unaware, HIWASH stands for:

• Headache
• Irritability
• Weakness
• Anxiety
• Shaky
• Hunger

Sugar is essential for the brain to function properly since it does not produce sugar alone. Insufficient amount of glucose in the body can lead to brain deficits, and the body will experience the above-mentioned HIWASH warning signs.

Nurses should be aware of these signs and symptoms with diabetic clients because if blood glucose levels fall to less than 40 mg/dl because they can go into a diabetic coma.  

Hyperglycemia

Compared to hypoglycemia, hyperglycemia is much less critical in a way that you can think of it as an overfilled fuel tank wherein you will have gasoline all over the place. Still, it won’t break down the car immediately. There is sufficient time to correct hyperglycemia, unlike with hypoglycemia, which is more perilous if not resolved or treated immediately.   

Going back to our normal blood sugar level in the bloodstream, the peak would be 105 mg/dl. When a person eats, the blood sugar is expected to rise beyond 105 mg/dl, reaching around 130 to 150 mg/dl. 

Those numbers are considered within the therapeutic range after a meal. However, if the body maintains 150 mg/dl and goes up to 200 or more, and it becomes consistent for years without getting diagnosed, problems will eventually arise.

Undiagnosed persistent hyperglycemia would result in thick, syrupy blood flowing throughout the body, directly affecting the brain, heart, eyes, kidneys, and even the fingertips. Once syrupy blood reaches those parts of the body, destruction will occur.

The consequences of hyperglycemia are:

• Optic nerve affectation that can lead to blindness
• Kidney failure
• Decreased oxygen in the distal portions (toes and fingers) resulting in neuropathy

So remember, a client most likely will not immediately die from hyperglycemia, but if it’s not treated, it will lead to a more pressing issue inside the body which is also known as diabetes.

The Three P’s of Hyperglycemia

Hyperglycemia has three signs and symptoms that nurses should monitor:

• Polyuria – frequent urination
• Polydipsia – excessive thirst
• Polyphagia – excessive hunger

To easily remember that, we have translated the three P’s into:

• Pee – having the urge to urinate constantly
• Pepsi – wanting to drink more
• Plates – wanting to eat more

Polyuria

Due to increased blood sugar level, the body has the urge to expel unnecessary, syrupy blood in the form of urine. Therefore, the body craves fluid to dilute the blood and eliminate sugar concentration.

Polydipsia

Pepsi is contraindicated with hyperglycemic clients; we just placed it there for you to easily remember that diabetics have this intense craving for fluid. This happens to be the main reason why polyuria happens.

Polyphagia

Hyperglycemic clients are constantly starving even with increased sugar in the bloodstream. This is because the cells are supposed to use the sugar in the blood to produce energy. 

Since glucose is not going inside the cells, they become hungry because glucose isn’t introduced due to lack or absence of insulin. There is no key to open the cell doors and let glucose in to be transformed into energy.

Types of Diabetes

There are two types of diabetes: type 1 and type 2.

Type 1 Diabetes

Going back to the Pirates of the Pancreas, the saltwater represents of the blood with high sugar levels. You’re on a pirate ship without means of filtering the saltwater, same with your cells that don’t have enough insulin to let glucose in. 

That’s the entire scenario with type 1 diabetes – there is no insufficient amount of insulin to accommodate huge amounts of sugar in the bloodstream.

The decline in insulin production is primarily due to beta cells not performing their specific task. And remember, beta cells are found in the islets of Langerhans. Beta cells secrete insulin, and without it, there won’t be the facilitation of insulin production. For this reason, type 1 diabetes clients require injectable insulin.

Insulin is never given orally or intramuscularly. Instead, insulin is administered:

1. Subcutaneously
2. Intravenously

Type 1 Diabetes and DKA

One of the major complications of type 1 diabetes is diabetic ketoacidosis (DKA) caused by ketones. There are three S’s that cause DKA, namely:

• Smoking
• Sepsis
• Sickness

Type 2 Diabetes

With this type of diabetes, you have to keep in mind that the body is already resistant to insulin, and this is due to an overworked pancreas. So to explain this condition further, let’s go back to the Pirates of the Pancreas analogy.

Let’s pretend that the pirates came to the pancreas and went to the islets of Langerhans, taking the resources of the island, and at the same time, overstimulating the islet of Langerhans.

Overstimulated beta cells inside the islets of Langerhans can lead to increased insulin production, resulting in the cells no longer responding to the insulin; thus, no glucose is going inside the cells. As a result, the body no longer recognizes insulin and becomes insulin-resistant.

One of the main reasons why there is an overworked pancreas is due to a person’s diet – high sugar, high cholesterol, and high fat. Increased amounts of simple carbohydrates can do a lot of damage in the system, specifically in the pancreas.

Type 2 Diabetes and HHNS

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a severe complication of type 2 diabetes. This threatening condition is due to severely increased amounts of sugar in the blood. One of the main manifestations is polyuria which can lead to dehydration.

For your nursing management, you have to remind your clients to consume a proper diet, particularly lessening foods high in carbohydrates.

Pancreas Study Takeaway

Here are two great ways to distinguish and remember which one leads to DKA or HHNS.

1. In the English alphabet, D comes before H; therefore, type 1 is for DKA and type 2 is for HHNS.
2. Between DKA and HHNS, which one has lower glucose? In reference to #1, since DKA came first, it has a lesser glucose level. HHNS, on the other hand, can even reach 300 mg/dl and above.

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