Carbohydrates

• D-Glucose [most important]

• D-Galactose _{[must be converted to glucose to be used as energy]}

• D-Fructose _{[must be converted to glucose to be used as energy]}

GGF

Enumerate the monosaccharides

• Maltose [ 2 Glucose]

• Lactose [Glucose + Galactose]

• Sucrose [Glucose + Fructose]

MLS

Enumerate the Disaccharides and what monosaccharide unit are they made of

• Starch

• Glycogen

• Cellulose

• Inulin [composed of Fructose unit only]

Enumerate the Polysaccharides

• Galactokinase

• 1-phosphate uridyl transferase

What are the enzyme deficiency will cause Galactosemia

• Guthrie test

• Beutler method

Galactokinase and 1-phosphate uridyl transferase deficiency can cause Galactosemia. What are the screening test done for this

• Whole Blood

• Plasma

• Serum

Carbohydrate Concentration

• Urine

• CSF

• Other body fluids

Specimen used for Carbohydrate Measurement

• Urine

• CSF

• Other Body Fluids

Carbohydrate Measurement

• Whole blood

• Plasma

• Serum

Specimen used for Carbohydrate Concentration

• Glycolysis

GLUCOSE METABOLISM:

• It is the metabolism of glucose to pyruvate or lactate for production of energy

• GLYCOLYSIS

  • Pyruvate

  • Lactate

To produce energy, glucose is metabolized into ______ and ______

• Gluconeogenesis

GLUCOSE METABOLISM:

• Formation of glucose-6-phosphate from noncarbohydrate sources

• Glycogenolysis

GLUCOSE METABOLISM:

• Breakdown of Glycogen to Glucose for use of energy

• Glycogenesis

GLUCOSE METABOLISM:

• Glucose to Glycogen for storage

• Lipogenesis

GLUCOSE METABOLISM:

• Conversion of carbohydrates to fatty acids

• Lipolysis

GLUCOSE METABOLISM:

• Decomposition of fat

• INSULIN —the only hormone lower glucose level

GLUCOSE REGULATING HORMONE:

• Hormone that lowers blood glucose level

• Inhibit Glycogenolysis and Gluconeogenesis

• Increase Glucose uptake by peripheral Tissue

GLUCOSE REGULATING HORMONE:

• What are the actions of Insulin (lower glucose level)

• Starvation (low dietary feul)

• Stress / Trauma (Epinephrine increases)

GLUCOSE REGULATING HORMONE:

• In what instances does Insulin (lower glucose) Decreases

• C-Peptide

GLUCOSE REGULATING HORMONE:

• Used as marker to differentiate Endogenous (body) and Exogenous (injected) insulin

• 5:1

GLUCOSE REGULATING HORMONE:

• C-Peptide to Insulin ration

• NV: <1.2 ng/mL

• Hyperinsulinism: >1.9 ng/mL

GLUCOSE REGULATING HORMONE:

• C-peptide normal value

• What level can cause hyperinsulinism

• Glucagon

• Epinephrine

• Cortisol

• Growth Hormone

• Thyroid Hormone

GLUCOSE REGULATING HORMONE:

• Enumerate hormone that increases Glucose Level

• Insulin ONLY

GLUCOSE REGULATING HORMONE:

• Enumerate hormone that decreases Glucose level

• Stimulate Glycogenolysis and Gluconeogenesis

• PRODUCED: Alpha Cell (Pancrease)

GLUCOSE REGULATING HORMONE:

• Action of Glucagon

• Produced by?

• Activate adrenylate cyclase producing cAMP

• cAMP activates phosphorylase which stimulates Glycogenolysis

  • PRODUCED: Chromaffin Cell (Adrenal Medula)

GLUCOSE REGULATING HORMONE:

• Action of Epinephrine

• Produced by?

• Promote protein catabolism and deamination, increasing Gluconeogenesis (protein → glucose)

• Inhibit Glucose uptake by tissue (storage)

• PRODUCED BY: Fascicular Cell (Adrenal Cortex)

• STIMULATED BY: Adrenocorticutrophic Hormone (ACTH)

GLUCOSE REGULATING HORMONE:

• Action of Cortisol

• Produced by?

• Inhibit Glucose uptake by cell (storage)

• Antagonize Insulin

• PRODUCED: Pituitary Gland

GLUCOSE REGULATING HORMONE:

• Action of Growth Hormone

• Produced by?

• Stimulate Glycogenolysis

• Accelerate Insulin Degradation

• Promotes Glucose Absorption by GIT

• PRODUCED: Thyroid Follicle (Thyroid Gland)

GLUCOSE REGULATING HORMONE:

• Action of Thyroid Hormone

• Produced by?

• Inhibit Insulin and Glucagon (Regulator)

• PRODUCED: Delta Cell (Pancrase)

GLUCOSE REGULATING HORMONE:

• Action of Somatostatin

• Produced by?

• 50-100 mg/dL

• 2.8-6.2 mmol/L (mg% to mM = 0.055)

Normal value of glucose is serum or plasma

• 45-100 mg/dL

• 10% lower than serum/plasma due to RBC glucose utilization

Normal value of glucose in Whole Blood

• 40-70 mg/dL

• 60-75% of serum/plasma

Normal values of glucose in CSF

• Folin-Wu

• Somogyi-Nelson

• Neocuproine

• Benedict

• Schaeffer-Hartmann Somogyi

[F,S, National Book Store]

GLUCOSE DETERMINATION TESTS:

• Enumerate the Reduction Methods (Copper Reduction)

• Hagedorn-Jensen

GLUCOSE DETERMINATION TESTS:

• Enumerate the Ferric Reduction Method

• Dubowski (Ortho-toluidine method)

• Anthrone Condensation

GLUCOSE DETERMINATION TESTS:

• Enumerate the Condensation Methods

• Glucose Oxidase (GOD) Coupled Reduction

• Polarographic GOD Method

GLUCOSE DETERMINATION TESTS:

• Enumerate the Enzymatic Methods

• Hexokinase Method

GLUCOSE DETERMINATION TESTS:

• The most specific methods and considered as reference method for glucose determination

• WHOLE BLOOD (Folin-Wu)

  • 10% sodium tungstate

  • 2/3N sulfuric acid

• SERUM (Somogyi-Nelson)

  • 5% zinc sulfate

  • 0.3N barium hydroxide

GLUCOSE DETERMINATION TESTS:

• State the sample used for Folin-Wu and Somogyi Nelson

• Include the chemical used for deproteinization

• Phosphomolybdate Reagent

• PRODUCED: Phosphomolybdenum blue

GLUCOSE DETERMINATION TESTS:

• In Folin-Wu what reagent does the cuprous oxide (Cu1+) reacts with and what is the formed product

• Arsenomolybdate

• PRODUCED: Arsenomolybdenum blue

GLUCOSE DETERMINATION TESTS:

• In Somogyi-Nelson what reagent does the cuprous oxide (Cu1+) reacts with and what is the formed product

• Ferricyanide Ions

GLUCOSE DETERMINATION TESTS:

• In Hagedorn-Jensen what ions is used

• Yellow Ferricyanide is reduced by glucose present to colorless ferrocyanide solution

GLUCOSE DETERMINATION TESTS:

• What is the principle of Hagedorn-Jensen

• Ferrocyanide is less likely to be reoxidized by air

GLUCOSE DETERMINATION TESTS:

• Why is ferrocyanide more advantagous than cuprous ions

• Condensation Method

  • Dubowski (Ortho-Touidine Method)

GLUCOSE DETERMINATION TESTS:

• Most specific nonenzymatic glucose determination

• Glucose is converted to gluconic acid and hydrogen peroxide. The presence of enzyme peroxidase , a chromogen is oxidized gives a colored complex

GLUCOSE DETERMINATION TESTS:

• In Glucose Oxidase (GOD) Coupled Reaction, glucose is converted into __________ and ______ in the presence of ________. The presence of enzyme ________, a chromogen is oxidized to give a colored complex

• p-aminophenzone (PAP) oxidized to quinone imine dye (pink/red)

• o-dianisidine oxidized to orange product

• o-toluidine oxidize to green product

• indophenol blue oxidize to blue product, iodide is oxidized to purple product

GLUCOSE DETERMINATION TESTS:

• Enumerate the chromogen used in GOD Coupled Reaction

• Glucose is phosphorylated by hexokinase and magnesium ions to form glucose-6-phosphate

• G-6-P turns to 6-phosphogluconolactione by G-6-PD, w/ the reduction of NAD or NADP

GLUCOSE DETERMINATION TESTS:

• Principle of Hexokinase Method

• Type1 DM [beta cell is damaged]

  • Type 2 [insulin is enough but cells don’t respond]

TYPES OF DIABETES:

• Insulin Dependent

• Type 2 DM

TYPES OF DIABETES:

• Seen in obese patients

• Type 2 DM

TYPES OF DIABETES:

• Most common 80-90% prevalence

• Type 2 DM

TYPES OF DIABETES:

• Usually inhereted (very strong)

• Type 1 DM [autoimmune]

TYPES OF DIABETES:

• Human Leukocytes Antigen (HLA) associated

• Type 2 DM

TYPES OF DIABETES:

• Beta cells are unable to produce insulin

Type 2 DM

TYPES OF DIABETES:

• Responsive to Oral Hypoglycemic Drugs

Type 1 DM

TYPES OF DIABETES:

• Unresponsive to Oral Hypoglycemic Drugs

Type 1 DM

TYPES OF DIABETES:

• Always require insulin treatment

Type 1 DM

TYPES OF DIABETES:

• Microcirculation vasculate affected

Type 2 DM

TYPES OF DIABETES:

• Macrocirculation vasculate affected

• Polyuria

• Polydipsia

• Polyphagia

What are the 3Ps of Diabetes Mellitus symptoms

Gestational Diabates

TYPES OF DIABETES:

• Diabetes during pregnancy

• Maturity-Onset Diabetes of the Young (MODY)

TYPES OF DIABETES:

• Rare form of diabetes that is inheried

• Latent Autoimmune Diabetes in Adult (LADA)

TYPES OF DIABETES:

• Slow-Progressing autoimmune diabetes

• Type 3c Diabetes

TYPES OF DIABETES:

• Diabetes that occur dur to other medical condition affecting the pancrease

• Fasting Blood Sugar (FBS)

• Random Blood Sugar (RBS)

• 2Hr Postprandial Test

• Oral Glucose Tolerance test (IGTT)

• Intravenous Glucose Tolerance Test (IVGTT)

• Glycosylated Hemoglobin (HbA1c)

• Fructosamine

Enemurate the Tests used to Diagnose Diabetes Mellitus

• FBS = 30-110 mg/dL

• RBS = 45-130 mg/dL

TEST IN DIAGNOSING DM:

• Normal values of FBS and RBS

• After 60-90 mins = highest glucose concentration

• After 2hr = equal to FBS (30-110 mg/dL)

TEST IN DIAGNOSING DM:

• Normal Glucose Level for 2Hr Postprandial Test

• Glycosylated Hemoglobin (HbA1c)

TEST IN DIAGNOSING DM:

• Monitor long-term glucose control

• Fructosamine

TEST IN DIAGNOSING DM:

• Monitor short-term glucose control

• 1-hr OGTT w/ 50g glucose load (no fasting)

  • <140 mg/dL [GDM ruled out]

  • >140 mg/dL [Dianostic Test should be done (3hr OGTT)]

DIAGNOSING GESTATIONAL DIABETES:

• What is the screening method used

• What is the anticipated result (w/ interpretation)

• 3hr OGTT w/ 100g Glucose Load (overnight fasting)

  • >140 mg/dL confirmed GDM

DIAGNOSING GESTATIONAL DIABETES:

• What is the diagnostic method

• 45 mg/dL

• less = hypoglycemia

Normal value of Plasma Glucose

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• Liver and Kidney Glucose-6-Phosphate

• Type II (Pompe)

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• All tissue alpha 1,4-glucosidase

• Type III (Cori-Forbes)

  • Type IV (Adersen) = brancher enzyme

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• All tissue debrancher enzyme

• Type IV (Adersen)

  • Type III (Cori-Forbes) = debrancher enzyme

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• All tissue brancher enzyme

• Type V (McArdle)

  • Type VI (Hers) = Liver phosphorylase

    Type IX = Liver phosphorylase kinase

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• Muscle phosphorylase

• Type IV (Hers)

  • Type V (McArdle) = Muscle Phosphorylse

  • Type IX = Liver Phosphorylase kinase

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• Liver phosphorylase

• Type IX

  • Type V (McArdle) = Muscle phosphorylase

  • Type IV (Hers) = Liver phosphorylase

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• Liver phosphorylase kinase

• Type VII (Tarui)

  • Type VII = adenylate

  • Type X = cAMP-dependent

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• Muscle and Liver phosphofructokinase

• Type VIII

  • Type VII (Tarui) = fructokinase

  • Type X = cAMP-dependent

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• Brain and Liver adenylate kinase

• Type X

  • Type VII (Tarui) = fructokinase

  • Type VIII = adenylate

TYPES OF HYPOGLYCEMIA: Enzyme Deficient

• Liver and Muscle cAMP-dependent kinase

• Whipple’s Triad

Hypoglycemia is diagnosed by