NERVES, HORMONES AND HOMEOSTASIS.

NERVOUS SYSTEM.

central nervous system(CNS)-brain and spinal cord-

peripheral nerves(connect the CNS to the limbs and organs)

composed of cells called neurons

-The nervous system is a network of specialized cells that communicate information about an animal's surroundings and itself. -It processes this information and causes reactions in other parts of the body.

STRUCTURE OF A MOTOR NEURON.

**The nervous system uses electrical impulses, which travel along the length of the cells (Neurons). ** The cell processes information from the sensory nerves and initiates an action within milliseconds. These impulses can travel at up to 250 miles per hour, while other Systems such as the Endocrine System may take many hours to respond with hormones.

Neurons are similar to other cells in the body because:

- are surrounded by a cell membrane. -have a nucleus that contains genes

-contain cytoplasm, mitochondria and other “ organelles”

-carry out basic cellular processes such as protein synthesis and energy production.

However, neurons differ from other cells in the body because:

-Neurons have specialized extensions called dendrites and axons. Dendrites bring information to the cell body and axons take information away from the cell body.

-Neurons communicate with each other through an electrochemical process.

-Neurons contain some specialized structures (for example, synapses) and chemicals (for example, neurotransmitters).

*GAPS (NODES) in the Myelin Sheath along the length of the Axon are known as the NODES OF RANVIER.

The Myelin Sheath both Insulates and Speeds Up transmission of Action Potentials through the Axon.

(Lipid Layer )

*Messages take the form of ELECTRICAL SIGNALS, and are known as IMPULSES. * A Neuron carries impulses in only ONE direction.

**Neurons can be classified into THREE TYPES:

A. SENSORY (RECEPTOR) NEURONS (AFFERENT) - Carry impulses from the SENSE ORGANS (RECEPTORS) to the Brain and Spinal Cord (CNS).  Receptors detect external or internal changes and send the information to the Central Nervous System in the form of impulses by way of the Afferent Neurons. B. MOTOR NEURONS (EFFERENT) - Carry impulses from the Brain and Spinal Cord to MUSCLES or GLANDS.  Muscles and Glands are Two Types of Effectors.  In response to impulses, Muscles Contract and Glands Secrete.

C.  INTERNEURONS or RELAY NEURONS - Connect Sensory and Motor neurons and carry impulses between them.  They are found entirely within the Central Nervous System.

MOTOR NEURON

SENSORY NEURON

A: afferent neuron B: efferent neuronC: interneuron

TRANSMISSION OF NERVE IMPULSES

1.The Italian scientist Luigi Galvani found that nervous tissue (groups of cells that conduct impulses) displays Electrical Activity in the form of a Nerve Impulse, which is a flow of electrical charges along The Cell Membranes of a Neuron.

Luigi Galvani1737-1798(direct current)-Stimulation experiment of Luigi Galvani. The electrochemical behavior of two dissimilar metals [(zinc (Z) and copper (C)] in a bimetallic arch, in contact with the electrolytes of tissue, produces an electric stimulating current that elicits muscular contraction.

2. This Electrical Activity is due to Movement of IONS (charge particles) across the Cell Membrane.  SODIUM - Na+, AND POTASSIUM - K+. 3. The movement of these Ions is affected by their ability to pass through the Cell membrane, their Concentration Inside and Out of the Cell, and Their Charge. 4. Neurons have an Electrical Charge Different from the Extracellular Fluid that surrounds them.  A difference in electrical Charge between Two Locations is called a POTENTIAL.

Lights, Camera, Action Potential!!

Much of what we know about how neurons work comes from experiments on the giant axon of the squid.

axon extends from the head to the tail of the squid is used to move the squid's tail 1 mm in diameter - easy to see with the naked eye.

Neurons send messages electrochemically chemicals cause an electrical signal

Chemicals in the body are "electrically-charged" (ions) The important ions in the nervous system are sodium and potassium (both have 1 positive charge, +), calcium (has 2 positive charges, ++) and chloride (has a negative charge, -). Nerve cells are surrounded by a membrane that allows some ions to pass through and blocks the passage of other ions /semi-permeable. )

Resting Membrane Potential When a neuron is not sending a signal, it is "at rest."

-the inside of the neuron is negative relative to the outside.

-At rest, potassium ions (K+) can cross through the membrane easily.

-chloride ions (Cl-)and sodium ions (Na+) have a more difficult time crossing

selective ion channels pump that uses energy to move three sodium ions out

of the neuron for every two potassium ions it puts in

when all these forces balance out, and the difference in the voltage between the inside and outside of the neuron is measured, you have the resting potential.

The resting membrane potential of a neuron is about -70 mV (mV=millivolt) - this means that the inside of the neuron is 70 mV less than the outside.

At rest, there are relatively more sodium ions outside the neuron and more potassium ions inside that neuron.

As a result of its Resting Potential, the Neuron is said to be POLARIZED.

POLARIZED = Negatively Charged on the inside of the Cell Membrane, and Positively Charged on the Outside.

A Neuron maintains this polarization until it is stimulated

A STIMULUS is a change in the environment that may be of

sufficient strength to initiate an impulse.

The ability of a neuron to respond to a Stimulus and Convert it into a nerve impulse is known as

EXCITABILITY.

THE MOVING IMPULSE

1.  A Nerve Impulse causes a movement of ions across the cell membrane of a neuron 2. The cell membrane of a neuron contains thousands of tiny molecules known as GATES. (Sodium and Potassium)

3. These Gates allow either Sodium or Potassium ions to pass through.

4. Generally the Gates on a neuron are CLOSED. 5. A Nerve Impulse STARTS when Pressure or other Sensory Inputs, Disturbs a Neuron's Plasma Membrane, causing Sodium Gates to OPEN. 6. At the beginning of an impulse, the Sodium Gates OPEN, allowing positively charged Na+ ions to flow INSIDE the Cell Membrane.

7. The INSIDE of the membrane temporarily becomes MORE POSITIVE than the OUTSIDE. THIS IS CALLED DEPOLARIZED . 8. The Membrane is now said to be DEPOLARIZED:  the charge inside the axon changes from negative to positive as sodium ions enter the interior.

9. As the impulse passes, the Potassium Gates OPEN, allowing positively charged K+ ions to FLOW OUT.  REPOLARIZED: the inside of the axon resumes a negative charge. 10. The membrane is now said to be REPOLARIZED.  Once again NEGATIVELY Charged on the INSIDE and POSITIVELY Charged on the OUTSIDE.

11. The DEPOLARIZATION and REPOLARIZATION of a Neuron Membrane is called an ACTION POTENTIAL. Action Potential is another name for a Nerve Impulse or simply an impulse.

12.  After a nerve impulse is period when the neuron is unable to conduct a nerve impulse called the REFRACTORY PERIOD.

13. The Refractory Period is a very short period during which the sodium-potassium pump continues to return sodium ions to the outside and potassium ions to the inside of the axon. THUS RETURNING THE NEURON TO RESTING POTENTIAL.

An impulse is not an electric current; it is a wave of Depolarization and Repolarization.  Or a nerve impulse is actually the movement of an action potential along a neuron as a series of voltage-

gated ions channels open and close. An impulse is much SLOWER than an electric

current.

Unlike an electric current, the STRENGTH of an impulse is ALWAYS the SAME.

There is either an impulse to a stimulus or there in not.  (ALL OR NOTHING)

Action Potential

**The resting potential tells about what happens when a neuron is at rest.

**An action potential occurs when a neuron sends information down an axon, away from the cell body.

"spike" or an "impulse"

explosion of electrical activity that is created by a depolarizing current.

Some event (a stimulus) causes the resting potential to move toward 0 mV.

When the depolarization reaches about -55 mV a neuron will fire an action potential. This is the threshold.

If the neuron does not reach this critical threshold level, then no action potential will fire.

Also, when the threshold level is reached, an action potential of a fixed sized will always fire...for any given neuron,

the size of the action potential is always the same. There are no big or small action potentials in one nerve cell - all action potentials are

the same size.

Therefore, the neuron either does not reach the threshold or a full action potential is fired - this is the "ALL OR NONE" principle.

So, again….

1. Action potentials are caused by an exchange of ions across the neuron membrane.

2. A stimulus first causes sodium channels to open.

3. Because there are many more sodium ions on the outside, and the inside of the neuron is negative relative to the outside, sodium ions rush into the neuron. 4. Remember, sodium has a positive charge, so the neuron becomes more positive and becomes depolarized.

5. It takes longer for potassium channels to open.

6. When they do open, potassium rushes out of the cell, reversing the depolarization.

7. Also at about this time, sodium channels start to close. 8. This causes the action potential to go back toward -70 mV (a repolarization). 9. The action potential actually goes past -70 mV (a hyperpolarization) because the potassium channels stay open a bit too long.

10. Gradually, the ion concentrations go back to resting levels and the cell returns to -70 mV.

And there you have it...the Action Potential.

Define resting potential and action potential (depolarization and repolarization).

resting potential: state or condition of a neuron that is not sending an impulse, it is at rest and it is negatively charge (-70mV). It is said to be polarized or negatively charge inside the membrane in relation with the outside.

action potential: occurs when a neuron sends information down an axon, away from the cell body. Action potentials are caused by an exchange of ions across the neuron membranedepolarization: when the sodium ions rush into a neuron, it becomes more positive than the outside, it is depolarized.c

repolarization: when the neuron goes back to its -70mV.

1.Resting membrane potential. Voltage-gated Na+ channels (pink) are closed (the activation gates are closed and the inactivation gates are open). Voltage-gated K+ channels (purple) are closed.

2.Depolarization. Voltage-gated Na+ channels open because the activation gates open. Voltage-gated K+ channels start to open. Depolarization results because the inward diffusion of Na+ is much greater than the outward diffusion of K+.

3.Repolarization. Voltage-gated Na+ channels are closed because the inactivation gates close. Voltage-gated K+ channels are now open. Na+

diffusion into the cell stops and K+ diffuse out of the cell, causing repolarizaton.

4. End of repolarization and afterpotential. Voltage-gated Na+ channels are closed. Closure of the activation gates and opening of the inactivation gates reestablish the resting condition for Na+ channels. Diffusion of K+ through voltage-gated channels produces the afterpotential.

5. Resting membrane potential. The resting membrane potential is reestablished after the voltage-gated K+ channels close.

(mV)

Time

Na+

diffuseinto cell

K+

diffuse outof cell

Time

(mV)

Time

(mV)

Time

(mV)

Time

K+

diffuse outof cell

(mV)

K+ channelclosed Na+ channel K+ channel

closed

Inactivationgate open

Activationgateclosed

K+ channelopened

K+ channelopened Na+ channel

Activationgateopened

Inactivation gate openK+ channelopened

Na+ channel K+ channelclosed

Activationgateclosed

Na+ channel K+ channel

Na+

K+

Na+

K+ K+

Inactivationgate closed

K+ channelopened

Activationgateopened

K+ channelopened Na+ channel

K+ K+

MYELIN SHEATH 1. Myelin Sheaths greatly increase the speed of impulse along an axon. 2. Myelin is composed of 80% lipid and 20% protein. 3. Myelin is made of special cells called Schwann Cells that forms an insulated sheath, or wrapping around the axon. 4. There are SMALL NODES or GAPS called the Nodes of Ranvier between adjacent myelin sheath cells along the axon.  5. As an impulse moves down a myelinated (covered with myelin) axon, the impulse JUMPS form Node to Node instead of moving along the membrane. 6. This jumping from Node to Node greatly increase the speed of the impulse. 7. Some myelinated axons conduct impulses as rapid as 200 meters per second. 8. The formation of myelin around axons can be thought of as a crucial event in evolution of vertebrates.

Destruction of large patches of Myelin characterize a disease called Multiple

Sclerosis.  In multiple sclerosis, small, hard plaques appear throughout the myelin.  Normal nerve function is impaired, causing symptoms such as double vision, muscular weakness, loss

of memory, and paralysis. The most common early symptoms of MS include:Muscle symptoms—muscle weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, or a lack of coordination. Visual symptoms—blurred, foggy, or hazy vision, eyeball pain (especially with movement), blindness, or double vision. Optic neuritis (a sudden loss of vision and eye pain) is a fairly common initial symptom, occurring in up to 23% of those who develop MS.*Diagnosis? Magnetic resonance imaging

• In unmyelinated axons the AP must be generated along the entire length of the axon (slow).

• In myelinated axons the myelin sheath blocks Na+ and K+ channels except at the nodes of Ranvier. The cable properties conduct positive charges from one node to the next and APs are only generated at the node. Fewer APs are needed to reach the end of the axon (fast).

Making Connections - The Synapse Neurons have specialized projections called dendrites and axons. Dendrites bring information to the cell body and axons take information away from the cell body. Information from one neuron flows to another neuron across a synapse.

The synapse is a small gap separating neurons. The synapse consists of:

1. a presynaptic ending that contains neurotransmitters, mitochondria and other cell organelles,2. a postsynaptic ending that contains receptor sites for neurotransmitters and,3. a synaptic cleft or space between the presynaptic and postsynaptic endings.

Electrical Trigger for Neurotransmission

For communication between neurons to occur, an electrical impulse must travel down an axon to the synaptic terminal.

Neurotransmitter Mobilization and ReleaseAt the synaptic terminal (the presynaptic ending), an electrical impulse will trigger the migration of vesicles (the red dots in the figure to the left) containing neurotransmitters toward the presynaptic membrane. The vesicle membrane will fuse with the presynaptic membrane releasing the neurotransmitters into the synaptic cleft. Until recently, it was thought that a neuron produced and released only one type of neurotransmitter. This was called "Dale's Law." However, there is now evidence that neurons can contain and release more than one kind of neurotransmitter.

Diffusion of Neurotransmitters Across the Synaptic Cleft

The neurotransmitter molecules then diffuse across the synaptic cleft where they can bind with receptor sites on the postsynaptic ending to influence the electrical response in the postsynaptic neuron.

In the figure, the postsynaptic ending is a dendrite (axodendritic synapse), but synapses can occur on axons (axoaxonic synapse) and cell bodies (axosomatic synapse).

When a neurotransmitter binds to a receptor on the postsynaptic side of the synapse, it changes the postsynaptic cell's excitability

it makes the postsynaptic cell either more or less likely to fire an action potential.

If the number of excitatory postsynaptic events is large enough, they will add to cause an action potential in the postsynaptic cell and

a continuation of the "message."

Many psychoactive drugs and neurotoxins can change the properties of neurotransmitter release, neurotransmitter reuptake and the availability of receptor binding sites.

http://faculty.washington.edu/chudler/toxin1.html

Neurotransmitters and Neuroactive Peptides (in 1921, an Austrian scientist named Otto Loewi discovered the first neurotransmitter )

1. are released from one neuron at the presynaptic nerve terminal.

2. Neurotransmitters then cross the synapse where they may be accepted by the next neuron at a specialized site called a receptor.

3. The action that follows activation of a receptor site may be either depolarization (an excitatory postsynaptic potential) or hyperpolarization (an inhibitory postsynaptic potential).

A depolarization makes it MORE likely that an action potential will fire; a hyperpolarization makes it LESS likely that an action potential will fire.

Neurotransmitter Types

There are many types of chemicals that act as neurotransmitter substances. Below is a list of some of them.

Small Molecule Neurotransmitter SubstancesAcetylcholine

(ACh)Dopamine

(DA)Norepinephrine

(NE)Serotonin (5-HT) Histamine Epinephrine

Amino AcidsGamma-aminobutyric acid (GABA)

Glycine

Glutamate

Aspartate

Soluble GasesNitric Oxide (NO)

Carbon Monoxide

Neuroactive Peptides - partial list!!

bradykinin beta-endorphin bombesin calcitonin

cholecystokinin enkephalin dynorphin insulin

gastrin substance P neurotensin glucagon

secretin somatostatin motilin vasopressin

oxytocin prolactin thyrotropin angiotensin II

sleep peptides galanin neuropeptide Y

thyrotropin-releasing hormone

gonadotropnin-releasing hormone

growth hormone-releasing hormone

luteinizing hormone

vasoactive intestinal peptide

• When the AP reaches the end of the axon it triggers opening of Ca++ channels and Ca++ diffuses into the axon. The Ca++ channels are voltage regulated.

• This triggers fusion of synaptic vesicles (contain NT) with the presynaptic membrane and release by exocytosis of the NT into the synaptic cleft.

• The NT binds to receptors in the postsynaptic membrane..

Chemical Synapse

• Binding the NT (Neurotransmitters) opens ion channels in the postsynaptic membrane. These are chemically (ligand) regulated channels.– This may depolarize the membrane –

excitatory postsynaptic potential (EPSP).– This may hyperpolarize the membrane –

inhibitory postsynaptic potential (IPSP)..

Acetylcholine boundto receptor site opensligand-gated Na+

channel

1. Action potentials arriving at the presynaptic terminal cause voltage- gated Ca2+ channels to open.

2. Ca2+ diffuse into the cell and cause synaptic vesicles to release acetylcholine, a neurotransmitter molecule.

3. Acetylcholine diffuses from the presynaptic terminal across the synaptic cleft.

4. Acetylcholine molecules combine with their receptor sites and cause ligand-gated Na+ channels to open. Na+ diffuse into the cell and causes depolarization. If depolarization reaches threshold, an action potential is produced in the postsynaptic cell.

Ca2+

Voltage-gatedCa2+ channel

Synapticvesicle

Postsynapticmembrane

Acetylcholine

4

Synaptic cleft

Action potential

Presynapticterminal

Na+

1

2

3

4

http://www.tvdsb.on.ca/westmin/science/sbioac/homeo/synapse.htm

ENDOCRINE SYSTEM.

consists of glands that release HORMONES that are transported in the blood.

Functions?Response to stress and injuryGrowth and developmentReproductionHomeostasisEnergy metabolism

HOMEOSTASIS involves maintaining the internal environment between limits, including:

-blood pH- carbon dioxide concentration-blood glucose concentration

-body temperature -water balance.

HOMEOSTASIS

How it works??All homeostatic control mechanisms have at least three

interdependent components for the variable being regulated: (1)The receptor is the sensing component that monitors and

responds to changes in the environment. When the receptor senses a stimulus, it sends information to a

(2) control center, the component that sets the range at which a variable is maintained. The control center determines an appropriate response to the stimulus. In most homeostatic mechanisms the control center is the brain. The control center then sends signals to an

(3) effector which can be muscles, organs or other structures that receive signals from the control center. After receiving the signal, a change occurs to correct the deviation by either enhancing it with positive feedback or depressing it with negative feedback

Control of body temperature or THERMOREGULATION.

(transfer of heat in blood, hypothalamus, sweat glands,,skin arterioles and shivering)

-In a healthy individual, body temperature is kept constant in a very small range despite of big differences in temperature of the surroundings and also those in physical activity (THERMOREGULATION)-The skin assists in homeostasis: it does this by reacting differently to hot and cold conditions so that the inner body temperature remains more or less constant. -Vasodilation and sweating are the primary modes by which humans attempt to lose excess body heat. -The brain creates much heat through the countless reactions which occur. Even the process of thought creates heat. In order keep the brain from overheating, the head has a complex system of blood vessels which bring blood to the thin skin on the head which allows heat to escape.

Thermoregulation in hot conditions

1) Sweat glands under the skin secrete sweat (a fluid containing mostly water with some dissolved ions) which travels up the sweat duct, through the sweat pore and onto the surface of the skin. This causes heat loss by evaporation; however, a lot of essential water is lost.

2) The hairs on the skin lie flat, preventing heat from being trapped by the layer of still air between the hairs. This is caused by tiny muscles under the surface of the skin called erector pili muscles relaxing so that their attached hair follicles are not erect. These flat hairs increase the flow of air next to the skin increasing heat loss by convection. When environmental temperature is above core body temperature, sweating is the only physiological way for humans to lose heat.

3) Arterioles Vasodilation occurs, this is the process of relaxation of smooth muscle in arteriole walls allowing increased blood flow through the artery. This redirects blood into the superficial capillaries in the skin increasing heat loss by convection and conduction.

Note: Most animals can't sweat efficiently. Cats and dogs only have sweat glands on the pads of their feet. Horses and humans are two of the few animals capable of sweating. Many animals pant rather than sweat, this is because the lungs have a large surface area and are highly vascularised. Air is inhaled, cooling the surface of the lungs and is then exhaled losing heat and some water vapour.

Thermoregulation in cold conditions

1) Sweat stops being produced. The errector pili muscles contract (piloerection), lifting the hair follicle upright. This makes our hairs stand on end which acts as an insulating layer, trapping heat. This is what also causes goose bumps since humans don't have very much hair and the contracted muscles can easily be seen.

2) Arterioles constrict, thereby rerouting blood away from the skin and towards the warmer core of the body. This prevents blood from losing heat to the surroundings and also prevents the core temperature dropping further. This process is called vasoconstriction.

3) Muscles can also receive messages from the thermo-regulatory center of the brain (the hypothalamus) to cause shivering. This increases heat production as respiration is an exothermic reaction in muscle cells. Shivering is more effective than exercise at producing heat because the animal remains still. This means that less heat is lost to the environment via convection.

Note: There are two types of shivering: low intensity and high intensity. During low intensity shivering animals shiver constantly at a low level for months during cold conditions. During high intensity shivering animals shiver violently for a relatively short time. Both processes consume energy although high intensity shivering uses glucose as a fuel source and low intensity tends to use fats. This is why animals store up food in the winter.

Convection is the transfer of heat by the actual movement of the warmed matter. Heat leaves the coffee cup as the currents of steam and air rise.

Hypothalamus, which is part of the brain, plays an important role in regulating the internal activities of the body.

Hypothalamus

Nerves connect the brain with the hypothalamus and the hypothalamus to virtually all regions of the nervous

system. The main function of the

hypothalamus is homeostasis, or maintaining the body's status quo. The hypothalamus controls a wide range of functions, such as blood

pressure, body temperature, fluid and electrolyte balance, and body weight.

The hypothalamus directs the "fight or flight" response of the autonomic nervous system. Fear or excitement

causes signals to travel to the hypothalamus, which triggers a rapid heartbeat, faster breathing, widening

of the pupils, and increased blood flow.

The hypothalamus monitors blood

glucose levels and the body's water

content to regulate appetite for food or drink. It regulates sleep and sexual

behavior.

The hypothalamus can be regarded as the thermostat controlling the

temperature of the body.

It initiates shivering and contraction or expansion of blood vessels.

The hypothalamus triggers behaviors such as putting on or removing clothes, turning

on the heat, or moving into the shade.

http://www.mansfieldct.org/schools/mms/staff/hand/convcondrad.htm

Control of blood glucose.(glucagon, insulin and α and β cells in

the pancreatic islets)

Blood sugar concentration, or glucose level, refers to the amount of glucose present in a mammal's blood. Normally, the blood glucose level is maintained at a reference range between about 4 and 6 mM (mmol/l) Normal blood glucose levels are about 90mg/100ml, equivalent to 5mM (mmol/l) Glucose levels rise after meals for an hour or two by a few grams and are usually lowest in the morning, before the first meal of the day. Transported via the bloodstream from the intestines or liver to body cells, Glucose is the primary source of energy for body's cells

There are two types of mutually antagonistic metabolic hormones affecting blood glucose levels:

catabolic hormones (such as glucagon, growth hormone, cortisol catecholamines, thyroxine and somatostatin), which increase blood glucose;

anabolic hormone (insulin), which decreases blood glucose.

INSULIN.

-produced by the beta cells (β cells) in pancreatic islets (islets of Langerhans) and released when the glucose level is too high

-1) Enhances entry of glucose into cells; 2) Enhances storage of glucose as glycogen , or conversion to fatty acids; 3) Enhances synthesis of fatty acids and proteins; 4) Suppresses breakdown of proteins into amino acids, of adipose tissue into free fatty acids.

-effect on blood glucose?: lowers

GLUCAGON.

-produced by the alfa cells (α cells) in pancreatic islets (islets of Langerhans) and released when the glucose level is too low

1) Enhances release of glucose from glycogen (in liver) by binding to glucagon receptors in hepatocytes; GLYCOGENOLYSIS

2) Enhances synthesis of glucose from amino acids or fatty acids, GLUCONEOGENESIS.

-effect on blood glucose?: Raises

Failure to maintain blood glucose in the normal range leads to conditions of persistently high (hyperglycemia) or low (hypoglycemia) blood sugar. Diabetes mellitus, characterized by persistent hyperglycemia from any of several causes, is the most prominent disease related to failure of blood sugar regulation.

Diabetes mellitus

Type 1– autoimmune-mediated destruction of insulin producing beta cells in the pancreas resulting in absolute insulin deficiency.

Type 2– multifactoral syndrome with combined influence of genetic susceptibility and influence of environmental factors, the best known being obesity, age, and physical inactivity, resulting in insulin resistance in cells requiring insulin for glucose absorption. This form of diabetes is strongly inherited.

Distinguish between type I and type IIdiabetes.