MTAP 1 CC1

brain RBCs retinal cells

Carbohydrates Provide energy to the:

sugar units found in the chain

Can be classified into 4 properties based on the number of

Glucose, Fructose, Galactose

example of Monosaccharides

1

Number of sugar units of monosaccharide

Maltose, Lactose, Sucrose

example of disaccharides

2

number of sugar units for Disaccharides

2-10

number of sugar units for oligosaccharides

Starch and Glycogen

examples of polysaccharides

>10

number of sugar units for polysaccharides

sucrose

only disaccharides that is also a non-reducing sugar.

Monosaccharides

cannot be further hydrolyzed because they are the simplest sugar.

glucose

only carbohydrate that could be directly use for energy.

Embden-Meyerhof Pathway
Hexose Monophosphate Pathway
Glycogenesis

Once the glucose is transported within the cell, it can
potentially enter three pathways:

Glucose-6-phosphate

Before entering into a pathway, glucose needs to be converted
into

Glycogenesis

Glucose to Glycogen

Glycogenolysis

Stored Glycogen to Glucose

Gluconeogenesis

Synthesis of glucose from non-carbohydrate sources

Glycolysis

Metabolism of Glucose for energy production

Lipogenesis

Carbohydrate to fatty acids

Insulin
Glucagon
Epinephrine
Cortisol
Growth hormone
ACTHThyroxine
Somatostatin

Regulation of Carbohydrate metabolism

insulin and glucagon

primary hormones for carbohydrate metabolism

INSULIN

Produce in the endocrine gland of pancreas, particularly in the β-cells of islets of Langerhans

Decreases plasma glucose level

primary function of insulin

Hypoglycemic agent

insulin is what kind of agent in the body?

Increasing the transport and entry of glucose
into the muscles.
Increasing glycogenesis
Increasing lipogenesis
Increasing glycolysis
Decreasing glycogenolysis

functions of insulin

GLUCAGON

Produced in the α-cells of islets of Langerhans

Increasing glycogenolysis
Increasing gluconeogenesis

functions of glucagon

Hyperglycemia

increase in the blood glucose concentration

Hypoglycemia

decrease in the blood glucose concentration

Type 1 Diabetes

Formerly known as “Juvenile-onset Diabetes” or “Insulin-Dependent DM”
Result from cellular-mediated autoimmune destruction of the β-cells
an absolute deficiency of insulin

Type 1 Diabetes

Genetically related that could be triggered by an environmental factor or viral infection
Ketosis tendency

10 to 20%

percentage of total DM cases that are type 1 DM

Polyphagia
Polyuria
Polydipsia

what are the three P's

Nephropathy
Neuropathy
Retinopathy

Microvascular – 3 pathy’s

Type 2 Diabetes

Formerly known as “Non-insulin Dependent” or “Adult-onset DM”
Resistance to insulin with an insulin secretory defect

equal or more than 6.5%

DIAGNOSTIC CRITERIA FOR DM

HbA1c

equal or more than 126 mg/dL or 7.0 mmol/L

DIAGNOSTIC CRITERIA FOR DM
Fasting plasma glucose

equal or more than 200 mg/dL or 11.1 mmol/L

DIAGNOSTIC CRITERIA FOR DM
Two-hour plasma glucose during an OGTT

equal or more than 200 mg/dL or 11.1 mmol/L

DIAGNOSTIC CRITERIA FOR DM
Random plasma glucose plus symptoms of diabetes

HbA1c, Fasting Blood Glucose, and OGTT.

considered appropriate method for DM diagnosis

only 1

Should the patient be tested using the 3 methods to diagnose him/her
with DM?

Gestational Diabetes Mellitus

Any degree of glucose intolerance with onset or first recognition during pregnancy.
Inability to properly metabolize glucose in GDM is usually caused by deficiency of insulin and metabolic and hormonal changes.

Macrosomic baby

baby born in a GDM mother.

respiratory syndrome, hypocalcemia, and hyperbilirubinemia

Macrosomic baby increased risk for?

equal or more than 92 mg/dL or 5.1 mmol/L

DIAGNOSTIC CRITERIA FOR GDM
Fasting plasma glucose

equal or more than 180 mg/dL or 10 mmol/L

DIAGNOSTIC CRITERIA FOR GDM
One-hour plasma glucose

equal or more than 153 mg/dL or 8.5 mmol/L

DIAGNOSTIC CRITERIA FOR GDM
Two-hour plasma glucose

65-50 mg/dL

Glucose level of ? considered hypoglycemic

50-55 mg/dL

Glucose level of ? considered hypoglycemic and with symptoms

lipids

primary sources of fuel in the body, that stabilize the cell membrane and allows transport of different molecules

lipoprotein

Lipids require ? as their special transport
carrier

Triglycerides
Phospholipids
Cholesterol
Cholesteryl esters

types of lipids

TRIGLYCERIDES

Composed of 3 fatty acids attached to a glycerol backbone
Hydrophobic – water fearing and water insoluble

12-14 hours

fasting requirement for trigly?

PHOSPHOLIPIDS

Most abundant lipid in the body
it only contains 2 esterified fatty acids attached to a phosphate group

hydrophobic

Fatty acid nonpolar tails are

hydrophilic

Phosphate head group is

CHOLESTEROL

Unsaturated steroid alcohol containing 4 rings AMPHIPHATIC
A precursor of major steroids

OH group

part of the cholesterol that is hydrophilic

CHOLESTERYL ESTERS

Similar to triglycerides, these are NEUTRAL lipids that are very polar, therefore are hydrophobic, hence found in the center of a lipid drop along with triglycerides

APOPROTEIN

protein part of the lipoprotein

CHYLOMICRONS

Largest and the least dense lipoprotein
Since they are so light, they readily float and form the CREAMY LAYER of plasma or serum

apo-B48 apo C-3 apo lipoprotein

apo protein present in chylomicrons

Apo B-100

Apoproteins found on the surface of VLDL is

VERY LOW-DENSITY LIPOPROTEIN

they are the major carriers of endogenous triglyceride
They are also responsible for the turbidity of plasma but do not form

CHYLOMICRONS

Its primary function is to deliver dietary lipids to hepatic and
peripheral cells (exogenous triglycerides)

LOW DENSITY LIPOPROTEIN

Core is rich in cholesterol, hence considered to be the most cholesterol rich among lipoprotein

LOW DENSITY LIPOPROTEIN

Most ATHEROGENIC
Responsible for the transport of cholesterol to the
peripheral tissues

HIGH DENSITY LIPOROTEIN

The smallest among all lipoproteins but most dense
Place a significant role in the REVERSE CHOLESTEROL TRANSPORT, which is the transport of the excess cholesterol from the tissues back to the liver
Most ANTIATHEROGENIC lipoprotein

DYSLIPIDEMIA

This is referred as the abnormal lipid concentrations

LDL receptors

Patients with FH are capable of synthesizing cholesterol however there is a problem with the ?

HYPERTRIGLYCERIDEMIA

This could also arise due to genetic abnormality resulting to Familial hypertriglyceridemia or it can be caused by other conditions secondary to other diseases

lipoprotein lipase or Apo C-II

In Familial hypertriglyceridemia, what is the deficient component? which keeps chylomicrons from being cleared hence elevating serum triglycerides

Familial Combined Hyperlipoproteinemia

In here, total cholesterol or the triglycerides could be elevated alone, or both are elevated

Apoprotein B

what protein is impaired in Familial Combined Hyperlipoproteinemia

Familial Dysbetalipoproteinemia

with the presence of apo E2/2 – which is a rare form of apo E, and iy cannot bind with hepatic A receptor therefore, impairing the uptake of VLDL and chylomicrons

HYPOBETALIPOPROTEINEMIA

Affects LDL, VLDL and chylomicrons
A point mutation in the Apo-B resulting to Apo-B Deficiency

Abetalipoproteinemia

Defective Apo B synthesis
VLDL, LDL and chylomicrons are not found in plasma
Defects in absorption of fat-soluble vitamins

HYPOALPHALIPOPROTEINEMIA

Affects LDL since it contains Apo A-1
Mutation in LCAT Apo A-1 and ABCA1 Transporter gene resulting to decreased HDL

Tangier’s Disease

Extreme form of hypoalphaproteinemia
HDL concentration is as low as 1-2 mg/dL

PRE-ALBUMIN

Plasma protein that is reached into tryptophan.
Responsible for transporting the:
o Thyroid hormones
o Vitamin A Retinol

Alcoholism
Chronic renal failure
Patients receiving steroids

causes of increased Pre-albumin

Diet is deficient in protein
Reduced hepatic synthesis

causes of decreased pre-albumin

ALBUMINS

Present in highest concentration
Responsible for the 8% of colloid osmotic pressure

Glycated albumin

Biomarker for serum glucose pattern approx. 1 month.

: 20 days

half-life of glycated albumin

Dehydration
Excessive albumin infusion

causes of increase albumin

Malnutrition and malabsorption
Liver disease
active nephrotic syndrome
Burns
Hypothyroidism
Analbuminemia
Bisalbuminemia
Hemodilution

causes of decrease albumin

GLOBULINS

Consists of α1, α2, β, γ
Not measure but calculated.

UREA

Major excretory product of protein metabolism
Has the highest plasma concentration

Urea N

Today, this term is used because it is more appropriate for UREA

Azotemia

Term for elevated urea in plasma

Uremia

Term for very high plasma concentration of urea accompanied by kidney failure

PRE-RENAL AZOTEMIA

Occurs due to reduced renal blood flow
Less urea filtered = less urea excreted

Stress, fever, major illness, corticosteroid
therapy, and GI hemorrhage

Increased protein catabolism due to

Congestive heart failure
Shock
Hemorrhage
Dehydration
High protein dietIncreased protein catabolism

symptoms for Pre-renal azotemia

RENAL AZOTEMIA

Problem in kidneys
Decreased renal function = increase plasma urea

Acute renal failure
Chronic renal failure
Glomerular nephritis
Tubular necrosis

examples of RENAL AZOTEMIA

POST-RENAL AZOTEMIA

Obstruction of urine flow

Renal calculi
Tumors of the bladder or prostate
Severe infection

examples of post-renal azotemia