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Clinical Chemistry > Carbohydrates > Flashcards

Carbohydrates Flashcards

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1
Q

How are carbs classified?

A

Grouped into generic classifications based on the number of carbons in the molecule

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2
Q

What is a Monosaccharide, Dissaccharide, Oligosaccharide, Polysaccharide

A

mono - 1 carbon
Diss - 2 carbon
Oligo - 3-10 carbons
Poly - 10+ carbons

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3
Q

Are carbs reducing substances?

A

Yes, these carbs can reduce other compounds while themselves are oxidized (remember the Clinitest)

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4
Q

Define Glucose

A

Glucose is the primary source of energy for humans.

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5
Q

Can the nervous system store/concentrate carbs?

A

No

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6
Q

What are the 3 possible metabolic pathways for glucose?

A
  1. Embden-Meyerhof pathway (hexokinase starts)
  2. Hexose monophosphate pathway (HMP) (G-6-phosphate)
  3. Conversion to glycogen
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7
Q

What is the 1st step for all 3 metabolic pathways for glucose?

A

First step for all three pathways requires glucose to be converted to glucose-6-phosphate using the high-energy molecule, ATP.

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8
Q

Define gluconeogenesis

A

Conversion of amino acids by the liver and other specialized tissue, such as the kidney, to substrates that can be converted to glucose

Formation fo glucose-6-phosphate from noncarbohydrate sources

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9
Q

What happens in the Embden-Meyerhof pathway?

A

Starts with 2 ATP molecules and ends with 4

Takes place in Mitochondria

Hexokinase starts

Conversion of amino acids by the liver and other specialized tissue, such as the kidney, to substrates that can be converted to glucose-6-phoshate is called gluconeogenesis

In anaerobic conditions, like in muscles, by converting pyruvic acid to lactic acid.

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10
Q

What happens in the Hexose monophosphate pathway (HMP)

A

Detours from Embden-Meyerhof path by converting glucose-6-phosphate to 6-phosphogluconic acid

Produces NADPH which is important to cells lacking mitochondria, preservation of cellular membranes and enzymes

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11
Q

Conversion to glycogen

A

Occurs when cellular energy needs are met

Acts as energy storage

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12
Q

Define glycolysis

A

Metabolism of glucose molecule to pyruvate or lactate for production of energy

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13
Q

Define Glycogenesis

A

Conversion of glucose to glycogen for storage

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14
Q

Define Glycogenolysis

A

Breakdown of glycogen to glucose for use as energy

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15
Q

Define Lipogenesis

A

Conversion of carbohydrates to fatty acids

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16
Q

Define Lipolysis

A

Decomposition of fat

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17
Q

What are all involved in controlling the blood glucose concentrations within a narrow range?

A

Liver, pancreas, and other endocrine glands are all involved in controlling the blood glucose concentrations within a narrow range.

18
Q

is the primary hormone responsible for the entry of glucose into the cell and therefore reducing blood glucose levels?

A

Insulin

19
Q

What is the primary hormone responsible for increasing blood glucose levels

A

Glucagon (liver muscle)

20
Q

What are the two hormones produced by the adrenal gland that affect carbohydrate metabolism?

A

Epinephrine
Glucocorticoids

21
Q

What is Epinephrine?

A

Produced by the adrenal medulla, increases plasma glucose. (skeletal muscle)

22
Q

What is Glucocorticoids?

A

Primarily cortisol, are released from the adrenal cortex on stimulation by adrenocorticotropic hormone (ACTH).

23
Q

What is Diabetes Mellitus?

A

A group of metabolic diseases characterized by hyperglycemia (increase in glucose) resulting from defects in insulin secretion, insulin action, or both

24
Q

What is Type 1 Diabetes Mellitus

A

B-cell destruction to absolute insulin deficiency and development of autoantibodies (includes latent autoimmune diabetes of adulthood)

“genetic”

Islet cell autoantibodies
Insulin autoantibodies
Glutamic acid decarboxylase autoantibodies
Tyrosine phosphatase IA-2 and IA-2B autoantibodies

5-10% of all cases

Commonly occurs in childhood with rapid onset

Tend to experience Ketoacidosis (buildup of ketones in blood)

Symptoms: Excessive thirst (polydipsia), increased food intake (polyphagia), excessive urination (polyuria), rapid weight loss, confusion, loss of consciousnesses

25
Q

What is Type 2 Diabetes Mellitus

A

Insulin resistance with an insulin secretory defect (due to progressive loss of adequate B-cell insulin secretion)

Relative insulin deficiency due to insulin resistance

“Acquired”

Occurs due to insulin resistance combined with insulin secretory defect

Most common form of Diabetes Mellitus

Associated with obesity and lack of physical exercise

Tends to occur in adulthood

26
Q

What is gestational diabetes?

A

Glucose intolerance during pregnancy diagnosed in the 2nd or 3rd trimester of pregnancy

27
Q

What is is lab findings in Hyperglycemia?
_____ insulin
_____ Glucose in plasma and urine
_____ Urine SG
_____ Serum and urine osmolality
_____ Blood and urine pH (acidosis)
Electrolyte imbalance
Are there Ketones in serum and urine? (Ketonemia and Ketonuria)

A

Decreased or absent insulin
Increased Glucose in plasma and urine
Increased Urine SG
Increased Serum and urine osmolality
Decreased Blood and urine pH (acidosis)
Electrolyte imbalance
Are there Ketones in serum and urine? (Ketonemia and Ketonuria)

28
Q

Impaired fasting glucose or Prediabetes

A

When fasting glucose is elevated but not to diabetic levels

Criteria for Testing:
- Habitually inactive
- Family History of Diabetes Mellitus
- At risk minority populations
- History of Gestational Diabetes (diabetes from pregnancy)
- Hypertension (high blood pressure)
- Low HDL cholesterol (good cholesterol)
- High Triglycerides (fat)
- Glycosylated Hemoglobin A1c ≥ 5.7
- History of glucose intolerance
- Insulin resistance

29
Q

Gestational Diabetes Mellitus

A

Any degree of glucose intolerance that occurs in the 2nd or 3rd trimester of pregnancy

Can lead to severe hypoglycemia of baby when umbilical cord is cut

Women who meet the criteria below in their prenatal visit should be diagnosed with Diabetes Mellitus not Gestational Diabetes Mellitus

30
Q

Pathophysiology of Diabetes Mellitus (symptoms)

A

Excessive thirst (polydipsia)
Increased food intake (polyphagia)
Excessive urination (polyuria)
Rapid weight loss
Confusion
Loss of consciousnesses
Glycosuria
Diabetic Keto Acidosis
Hyperkalemia from the displacement of Potassium
Heart Disease
Stroke
Pancretatits (inflammation)

31
Q

Criteria for Diagnosis of Diabetes Mellitus

A

Normal glucose = 74 - 100 mg/dL
Impaired fasting glucose = 100 - 125 mg/dL
Provisional diabetes diagnosis = > 126 mg/dL

32
Q

Criteria for the Testing and Diagnosis of Gestational Diabetes Mellitus

A

Plasma glucose decreases as hours of test increases

One step:
Fasting plasma glucose = > 92 mg/dL
1-h plasma gl = >180 mg/dL
2-h plasma gl = >153 mg/dL

Two step:
Fasting plasma glucose = > 95 mg/dL
1-h plasma gl = > 180 mg/dL
2-h plasma gl = > 155 mg/dL
3-h plasma gl = > 140 mg/dL

33
Q

Hypoglycemia

A

Involves decreased plasma glucose levels and can have many causes—some are transient and relatively insignificant, but others can be life threatening

Level 1 (glucose alert value) = < 70 mg/dL
Level 2 (clinically significant hypoglycemia) = < 54 mg/dL
Level 3 (severe hypoglycemia) = No specific glucose threshold….below range

34
Q

Methods of glucose measurement

A

Serum (no anticoagulant), plasma, or whole blood

Hexokinase method measured at 340 nm (wavelength being isolated)

35
Q

Sample integrity

A

Sample must be separated, serum/plasma poured off and refrigerated within 1 hour to maintain specimen integrity

Use serum or Plasma from lithium/sodium heparin or sodium flouride

Fasting blood glucose levels are to be collected after 8-10 hours of fasting, no more than 16 hours

Falsely increased by reducing agents

Hemolyzed and Icteric (yellow) samples may by falsely decreased

36
Q

Glucose Tolerance Testing

A

Purpose is to evaluate how the body reacts to glucose

Procedure begins with a fasting glucose level

Patient orally consumes a 75 g glucose solution

2 hours later another glucose level

If the 2 hour glucose result is >200 mg/dL the patient is diagnosed with Diabetes Mellitus

Glucose level is drawn every hour for evaluation of pregnant women

Normal glu tolerance = < 140 mg/dL
Impaired glu tolerance = 140 - 199 mg/dL
Provisional diabetes diagnosis = > 200 mg/dL

37
Q

Glycosylated Hemoglobin

A

Defined as the formation of a hemoglobin compound when glucose (a reducing sugar) reacts with the amino group of hemoglobin

Rate of formation is directly proportional to plasma glucose levels over 3 months

HbA1c is most commonly measured glycosylated Hemoglobin

Normal range is 4.0% - 6.0% (< 5.7% < 39 mmol/mol)

Uses EDTA whole blood sample

38
Q

Ketones

A

Produced by the liver through metabolism of fatty acids to provide a ready energy source from stored lipids at times of low carbohydrate availability

39
Q

Albuminuria

A

An early sign that diabetic kidney disease is occurring is an increase in urinary albumin.

40
Q

Islet Autoantibody, Insulin Testing, and C-Peptide Testing

A

Presence of autoantibodies to the β-islet cells of the pancreas is characteristic of type 1 diabetes.

Clinical Chemistry (6 decks)

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