ANATOMY AND PHYSIOLOGY

Every cell in the human body needs energy in order to function. The
bodys primary source of energy is glucose, a simple sugar resulting from
the digestion of foods containing carbohydrates (sugars and starches).

The organ that plays a major role in the metabolism of glucose

and the regulation of blood glucose concentration is the liver.

The Liver

The liver is the largest organ in the body. It is located behind the ribs
in the upper right portion of the abdominal cavity. It is divided into 4 lobes
and is suspended from the diaphragm and abdominal wall by a delicate
mesentery cord, the falciform ligament.

The functions of the liver are for glucose metabolism, ammonia

conversion, protein metabolism, fat metabolism, vitamin and iron storage,
drug metabolism, bile formation and bile excretion.

Glucose Metabolism

After a meal, glucose is taken up from the portal venous blood by the
liver and converted into glycogen, which is stored in the hepatocytes.
Subsequently, the glycogen is converted back to glucose (glycogenolysis)
and release as needed into the bloodstream to maintain normal levels of
blood glucose. This process however, provides a limited amount of glucose.
Additional glucose can be synthesized by the liver through a process called
glyconeogenesis, the liver uses amino acids from protein breakdown or
lactate produced by exercising muscles.

Insulin is the primary hormone that lowers the blood glucose level.
This level is being secreted by the beta cells of the pancreas.

The Pancreas

The pancreas is a gland in the digestive and endocrine system. It is a

soft, pink, triangular gland that extends across the abdomen from the spleen
to the duodenum. It has exocrine and endocrine functions. Its exocrine
functions include secretion of pancreatic enzymes into the gastrointestinal
tract through the pancreatic duct. Its endocrine functions include secretion
of insulin, glucagon and somatostatin.

Endocrine Pancreas

The islet of Langerhans, the endocrine part of the pancreas, are

collections of cells embedded in the pancreatic tissue. They contain the alpha
cells which secrete the glucagon, the beta cells which secrete insulin, and
the delta cells which secrete somatostatin.

The effect of glucagon (opposite to that of insulin)is chiefly to raise

the blood glucose by converting glycogen to glucose in the liver. It is
secreted by the pancreas in response to a dcrease in the level of blood
glucose.

The somatostatin exerts a hypoglycemic effect by interfering with the

release of growth hormone from the pituitary and glucagon from the
pancreas, both of which tend to raise blood glucose levels.

The major action of the insulin is to lower blood glucose by permitting

entry of glucose into the cells of the liver, muscle and other tissues.

In those cells, insulin:

- Transports and metabolizes glucose for energy

- Stimulates storage of glucose in the liver and muscle (in the form of
glycogen)
- Signals the liver to stop the release of glucose
- Enhances storage of dietary fat in adipose tissue
- Accelerates transport of amino acids (derived from dietary protein)
into cells)
 REGULATION OF BLOOD GLUCOSE LEVELS

Food intake

Digestion of food

blood glucose levels

Pancreatic beta cells are activated

Release of insulin to the blood

Uptake of glucose from Storage of the glucose in the liver in the

blood by the cells form of glycogen

blood glucose levels

Pancreatic alpha cells are activated

Release of glucagon into blood( target: the liver)

Stimulation of liver to breakdown stored glycogen into glucose

Release of glucose to the blood

blood glucose levels to homeostatic set point

Stimulus for glucagon release diminishes