Hypochlorhydria

Metabolic acidemia

Dehydration

Figure 22 Insulin deficiency results in increased hepatic glucose production and, hence, hyperglycemia by increased gluconeogenesis and glycogenolysis. Insulin deficiency also results in increased proteolysis releasing both glucogenic and ketogenic amino acids. Lipolysis is increased, elevating both glycerol and non-esterified fatty acid levels which further contribute to gluconeogenesis and ketogenesis, respectively. The end result is hyperglycemia, dehydration, breakdown of body fat and protein, and acidemia

Hypochlorhydria
Figure 23 Constituents of normal pancreas, medium-power view: to the left lies an excretory duct and, to the right, there is an islet surrounded by exocrine acinar cells. Hematoxylin and eosin stain
Immunostaining Islet

V* Figure 25 Normal islet immunostained for glucagon. Note that the a-cells mark the periphery of blocks of endocrine Figure 24 Normal islet immunostained for insulin. The cells within the islet. Most of the cells within these blocks majority (80%) of the endocrine cells are P-cells are p-cells

Hypochlorhydria

Figure 26 Normal islet immunostained for somatostatin. Somatostatin is contained in the D cells which are scattered within the islet. Somatostatin has an extremely wide range of actions. It inhibits the secretion of insulin, growth hormone and glucagon and also suppresses the release of various gut peptides. Somatostatinomas (D cell tumors) cause weight loss, malabsorption, gallstones, hypochlorhydria and diabetes

Figure 26 Normal islet immunostained for somatostatin. Somatostatin is contained in the D cells which are scattered within the islet. Somatostatin has an extremely wide range of actions. It inhibits the secretion of insulin, growth hormone and glucagon and also suppresses the release of various gut peptides. Somatostatinomas (D cell tumors) cause weight loss, malabsorption, gallstones, hypochlorhydria and diabetes

Storage Granules Micrograph

Figure 28 Electron micrograph of insulin storage granules (higher power view than in Figure 27) in a patient with an insulinoma

Normal Pancreas Electron Microscope

Figure 27 Electron micrograph (EM) of an islet of Langerhans from a normal pancreas showing mainly insulin storage granules in a pancreatic p-cell. A larger a-cell is also seen. The normal adult pancreas contains around 1 million islets comprising mainly p-cells (producing insulin), a-cells (glucagon), D cells (somatostatin) and PP (pancreatic polypeptide) cells. Islet cell types can be distinguished by various histologic stains and by the EM appearances of the secretory granules (as seen here). They can also be identified by immunocytochemical staining of the peptide hormones on light or electron microscopy (see Figures 24 and 25)

Figure 27 Electron micrograph (EM) of an islet of Langerhans from a normal pancreas showing mainly insulin storage granules in a pancreatic p-cell. A larger a-cell is also seen. The normal adult pancreas contains around 1 million islets comprising mainly p-cells (producing insulin), a-cells (glucagon), D cells (somatostatin) and PP (pancreatic polypeptide) cells. Islet cell types can be distinguished by various histologic stains and by the EM appearances of the secretory granules (as seen here). They can also be identified by immunocytochemical staining of the peptide hormones on light or electron microscopy (see Figures 24 and 25)

Figure 28 Electron micrograph of insulin storage granules (higher power view than in Figure 27) in a patient with an insulinoma

Diabetic Dermopathy
Figure 29 Insulitis. Histologic section of pancreas from a child who died at clinical presentation of type 1 diabetes mellitus. There is a heavy, chronic, inflammatory cell infiltrate affecting the islet. H & E
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