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Chemistry > Carbohydrate Metabolism > Flashcards

Carbohydrate Metabolism Flashcards

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1
Q

Carbohydrates Info

A

Major source of calories in diet
(CH2O)n = Hydrates of carbon
Aldehyde or ketone compounds with multiple hydroxyl groups

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2
Q

Aldose

A

Simple carbohydrate with 1 aldehyde

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3
Q

Ketose

A

Simple carbohydrate with 1 ketone group

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4
Q

Classification of Carbohydrates

A

Monosaccharides
Oligosaccharides/Disaccharides
Polysaccharides
Glycogen

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5
Q

Monosaccharides

A

Hexoses
Pentoses

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6
Q

Hexoses

A

6 carbon sugars
Glucose
Frustrose
Galactose

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7
Q

Pentoses

A

5 carbone sugars
Ribose
Deoxyribose

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8
Q

Oligosaccharides/Disaccharides

A

Sucrose
Lactose
Maltose

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9
Q

Sucrose

A

Glucose + Fructose

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10
Q

Lactose

A

Glucose + Galactose

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11
Q

Maltose

A

Glucose + Glucose

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12
Q

Polysaccharides

A

Long chain of branched carbohydrates
Contain 25-2500 glucose units
Starch

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13
Q

Starch

A

Plant carboyhydrate storage
Amylose and amylopectin subunits

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14
Q

Glycogen

A

Animal cell carbohydrate storage form

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15
Q

Digestion

A

Amylase
Disaccharidases

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16
Q

Amylase

A

Salivary Gland breaks polysaccharides into dextrins & maltose
Pancreatic amylase breaks polysaccharides into maltose

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17
Q

Disaccharidases

A

Brush border of intestine
Maltose, lactose, sucrose breaks into glucose, galactose, fructose

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18
Q

Monosaccharides Info

A

Enter GI circulation
Transported to liver

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19
Q

Glucose info

A

Sole source of body energy and only source of energy for some cells
Galactose, fructose go into liver and break down into glucose

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20
Q

Immediate energy needs of body

A

Met by aerobic and anaerobic glycolysis

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21
Q

Aerobic Glycolysis

A

Yields greatest amount of ATP
glucose converts into acetyl CoA and into Krebs (TCA) cycle
Clean metabolism: H2O + CO2

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22
Q

Anaerobic Glycolysis

A

Yields less ATP
Lactate must be cleared from the body
Glucose breaks down into pyruvate or lactate

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23
Q

Glucose storage

A

Liver glycogen: glycogenesis
Long term fasting: gluconeogenesis

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24
Q

Glycogenesis

A

Most immediate form of glucose in fasting state
Breakdown of glycogen

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25
Q

Gluconeogenesis

A

Formation of glucose from non-carbohydrate sources (amino acids, lactate, glycerol portion of lipids)

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26
Q

Hormonal Control of Circulating Glucose

A

Insulin
Glucagon
Growth Hormone
Glucocorticoids (Cortisol)
Adrenal/Epinephrine
Thyroxine (T4)

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27
Q

Insulin Info

A

Peptide hormone
Secreted by beta cells of islets of Langerhans
Turned on by elevated blood glucose
Binds to surface of body cells increasing membrane permeability to glucose
Stimulates synthesis of glycogen, lipids, and proteins
Body weight impacts the amount of insulin secreted

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28
Q

Hormones Antagonistic to Insulin

A

Glucagon
Adrenal/Epinephrine
Thyroxine (T4)
Growth Hormone
Glucocorticoids (Cortisol)

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29
Q

Glucagon

A

Polypeptide
Secreted by the alpha cells of the islets of Langerhans
Turned on by low blood glucose levels
Stimulates glycogenolysis and gluconeogenesis

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30
Q

Adrenal/Epinephrine

A

Adrenal medulla catecholamine
Stimulates glucogenolysis and lipolysis
Released in response to physical and emotional stress

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31
Q

Thyroxine (T4)

A

Thyroid amino acid hormone
Stimulates glycogeolysis and absorption of rate of glucose

32
Q

Growth Hormone

A

Anterior pituitary polypeptide hormone
Stimulates glycogenolysis and inhibits glucose uptake by tissues

33
Q

Glucocorticoids (Cortisol)

A

Adrenal cortex steroid hormone
Stimulates gluconeogensis

34
Q

ADA Guidelines

A

Meet criteria on two subsequent days
- Symptoms of diabetes + random plasma glucose of >200 mg/dL
- A fasting plasma glucose >126 mg/dL
- During GGT, 2 hr after oral glucose, plasma glucose >200 mg/dL
- Glucose values between 105-125 mg/dL = impaired fasting glucose

35
Q

Different Testing for Glucose

A

Random blood glucose
Fasting blood glucose
2-hours post prandial (after a meal)
Oral glucose tolerance test (GTT)
Serum and urine glucose and ketone bodies
Glycated Hemoglobin

36
Q

Random Plasma Glucose

A

Collection not in relationship to time of last meal
>200 mg/dL = Presumptive Diabetes

37
Q

Fasting Plasma Glucose

A

8 hour fast
Blood glucose level above reference range
- 105-125 mg/dL = Impaired fasting
- >126 mg/dL = Presumptive Diabetes

38
Q

2 Hour Postprandial Glucose

A

Postprandial
Can give a standard glucose load of 75 g of glucose in solution or eat a carbohydrate rich meal
- >200 mg/dL = Diabetes mellitus
- <140 mg/dL = Normal
- 140-199 mg/dL = Impaired glucose tolerance

39
Q

Oral Glucose Tolerance Testing (GTT)

A

Not the best test for diagnosing diabetes
May put undue stress on a diabetic
- Patient fasts for 8 hours
- Draw fasting blood glucose and collect fasting urine sample
- Ingest 75 g glucose load within 5 minutes
- Collect sampels at 30, 60, 120, and 180 minutes
- Time may be extended to 5 hours for hypoglycemia

40
Q

Normal glucose response during GTT

A

30 min-1 hour: glucose elevates & insulin turned on
1-2 hours: glucose begins to fall under action of insulin
At 2 hours glucose has returned to normal reference range
3-5 hours: glucose remains in fasting range under action of antagonistic hormones

41
Q

Abnormal glucose response during GTT

A

Fasting Blood Glucose: above reference range
30 min-1 hour: glucose elevates, insulin not secreted or not secreted in adequate amount
1-2 hours: Blood glucose level continues to rise
2 hours: glucose well above the reference range, glucosuria often present
3-5 hours: unregulated glucose remains high

42
Q

Specimen Preparation

A

Separate sample from cells (lose 7% of glucose/hr)
Once separated, sample is stable 1 day at RT and several days if refrigerated
Gray Top tube: contains sodium fluoride which inhibits glycolysis

43
Q

Methodology Serum or Plasma

A

Hexokinase
Glucose Oxidase

44
Q

CSF Glucose

A

Concentration of glucose in CSF is about 2/3 of serum glucose level

45
Q

Urine glucose

A

Blood glucose > renal threshold (180 mg/dL) = glucosuria
Associated with diabetes mellitus
Pregnant women may have lowered renal thresholds
- if glucose + on UA: test for diabetes
Benedict’s test: Alkaline CuSO4 measures reducing substances
Strip method: glucose oxidase

46
Q

False Positive with Benedict’s test

A

Vitamin C
Uric Acid
Creatinine
Other Reducing sugars

47
Q

False positive with oxidizing agents

A

Bleach
H2O2

48
Q

Ketone Bodies

A

Formed when fat used as sole energy source
Assay for ketone bodies in serum and urine of Type 1 diabetics
Provide an indicator of the degree of ketosis

49
Q

Methodology for Ketone

A

Sodium nitroprusside (purple +)
Reference range: Negative

50
Q

Glycated Hemoglobins

A

Hgb A1a, Hgb A1b, Agb A1c (80% og Hb A1)
AKA glycosylated hemoglobin, glycohemoglobin

51
Q

Formation of Glycated Hgb

A

When glucose reacts with amino group on hemoglobin to form ketoamine

52
Q

Hgb A1C

A

Formation is increased if the blood glucose is elevated
Provides an indicator of control over past 2-3 months

53
Q

ADA guidelines Hgb A1C

A

Test 2x/year if under good control
Test quarterly if therapy changes

54
Q

Hgb A1C reference ranges

A

3-6%
Control over past 2 months = Gly Hgb <7%

55
Q

Glycosylated Hemoglobin Methodology

A

Test performed on EDTA whole blood
Methods based on charge difference
Methods based on structural difference

56
Q

Hgb A1C Charge Difference Methods

A

Ion exchange column separates Hgb A1C from other forms of Hgb
Electrophoresis and isoelectric focusing

57
Q

Hgb A1C Structural Difference Methods

A

Immunoassay methods
Point of Care Devices
High performance liquid chromatography

58
Q

Urine Microalbumin Info

A

Diabetes associated renal disease
Loss of albumin into urine

59
Q

Urine Microalbumin ADA recommends

A

Annual screening
- Random urinary albumin/creatinine ratio
- 24 hour urine albumin
- 4 hour urine albumin

60
Q

Urine Microalbumin Test Results

A

30-300 mg/day = reversible
>550 mg/day = not reversible

61
Q

Primary Diabetes mellitus Info

A

Disorder of insulin production (absolute or relative)
Beta cells of the islets of Langerhans

62
Q

Glucosuria

A

Glucose in urine

63
Q

Polyuria

A

Large urine volume

64
Q

Polydipsia

A

Large water intake from excessive thirst

65
Q

Clinical Outcomes of Long-Term Out of Control Diabetes

A

Circulatory problems causing ulcers leading to amputation
Diabetic neuropathy
Atherosclerosis
Heart attack
Stroke
Nephrosclerosis
Kidney transplants
Retinopathy
Lead to blindness

66
Q

Diabetic ketoacidosis

A

Sweet smelling breath
Rapid breathing
Lowered blood pH
Other complications
Diabetic diuresis (increase osmolality)
Diabetic coma

67
Q

Type 1 Diabetes

A

Juvenile onset or absolute (IDDM)
High fasting glucose
NO insulin production
Autoimmune in nature

68
Q

Type 1 Diabetes Testing

A

GTT does not return to normal 1-3 hours
Glucose remains high in absence of insulin
Urine = Positive for glucose
Ketone bodies produced if patient is burning fat and glucagon levels are high

69
Q

Type 2 Diabetes

A

Mature onset or relative (NIDDM)
Familial association

70
Q

Type 2 Diabetes Testing

A

Glucose above normal at 2 hr postprandial
Urine = Positive for glucose if >RT
May develop ketosis
Familial association

71
Q

Secondary Causes of Hyperglycemia

A

Hormonally related
Acromegaly (elevated cortisol)
Cushing’s syndrome (rare - elevated thyroxine)
Hyperthyroidism

72
Q

Gestational Diabetes mellitus

A

Diabetes expressed during pregnancy
Family history
Babies are large (4000 grams)
Mother may return to normal after pregnancy (could develop DM later in life)

73
Q

Hypoglycemia

A

Blood glucose <50 mg/dL
Associated with coma because of cerebral dependence on glucose
Patient may present with lethargy and confusion

74
Q

Causes of Hypoglycemia

A

Insulin or drug induced

75
Q

Fasting hypoglycemia

A

Insulinoma

76
Q

Reactive hypoglycemia

A

Insulin over production

Chemistry (11 decks)

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