carbohydrates Flashcards
what are the 4 main and primary biomolecule in our body?
protein
nucleic acid
carbohydrates
lipids
what are the functions of carbohydrates
o Provide energy to the body (main)
o Part of the structural elements of some cells and tissues
a carbohydrate that is a complex carbohydrate
structural component of plants
cellulose
Primary source for brain erythrocytes and retinal cells in human
carbohydrates
Major food source and energy supply of the bod
carbohydrates
carbohydrates can be Stored primarily as ___
liver and muscles glycogen
Central ingredient for life
carbohydrates
what are the elements or compounds comprising the carbohydrates
compounds containing C, H
and O
what are the 2 main functional groups of carbohydrates
aldehyde
ketones
what is the general formula for carbohydrates
Cx(H20)y
why protein has a different checmical formula aside from the other biomolecules?
it has nitrogen
derivatives of carbohydrates
phosphates, sulfates and amines
carbohydrates are can be classified depending on the amount of sugar
name them all
monosaccharide
disaccharide
oligosaccharide
polysaccharide
how many sugars are thre in oligosaccharide?
2-10
how many sugar are there in polysaccharide?
greater than 10
__ is the simplest carbohydrate
Glycol aldehyde (CHO). or glyceraldehyde
__ is the only carbohydrate to be directly used by the cell with the help of insulin, it is quickly metabolized.
Glucose
The brain is completely dependent on blood glucose
for energy production -____ of glucose utilization in
resting adults accounts in the central nervous system
(CNS).
2/3
Glucose metabolism generates __, __, ___as intermediate products
pyruvic acid, lactic acid, and acetyl coenzyme A
an intermediate products that is a pathway to ATP production
pyruvic acid
an intermediate product that is formed in anaerobic conditions
lactic acid
what is the enzyme found in the mouth that will breakdown foods to create a polysaccharide
salivary amylase
salivary amylase will breakdown __ to produce a polysaccharide called ___
starch; maltose
is there a digestion of carbohydrates happening in the stomach?
none
why is there no digestion of carbohydrates happening in the stomach?
because of too high acidity caused by the hydrochloric acid making it deactivated
an enzyme that will help in breaking down carbs in pancreas and liver is called
pancreatic amylase
pancreatic amylase will breakdown ___ into shorter carbohydrate chain
dextrin
the enzyme sucrase will breakdown sucrose into ___
glucose and fructose
the enzyme maltase will breakdown between the 2 units of
2 glucose units of maltose
the enzyme lactase willbeakdown lactose into
galactose and glucose
example of reducing substances or sugars
glucose, maltose,
fructose, lactose and galactose
The presence of a double bond and a negative
charge in the enol anion makes ___ an active reducing substance.
glucose
what is the most common non reducing sugar?
sucrose
what does it mean to be a nonreducing sugar?
Nonreducing sugar do not contain an active ketone or aldehyde group.
carbohydrates can be classified based on the number of carbons
what is known to be a center carbon of sugar
anomeric carbon
3 carbon compounds is called
trioses
4 carbon compounds is called
tetroses
5 carbon compounds is called
pentoses
6 carbon compounds is called
hexoses
among the classification based on the number of carbons, which one is the most important?
pentoses
what will be the term for the compound if the CO functional group is a sugar
aldose
what will be the term for the compound if the CO functional group is a ketone
ketose
Models to Represent Carbohydrat
Fischer Project
Haworth Projection
Has the aldehyde or ketone at the top of the drawing
Fischer Projection
Carbons are numbered starting at the aldehyde or
ketone end
Fischer Projection
Straight chain or cyclic (linked in hemiacetal form)
Fischer Projection
Cyclic form
Haworth Projection
what is the fdifference between ketose and aldose in terms of the formula?
aldose C= O-H
Ketose C= O
ketose has no hydrogen attached
More representative of the actual structue
Haworth Projection
Formed when the functional group (ketone or
aldehyde) reacts with an alcohol group on the same
sugar to form a ring (hemiacetal ring)
Haworth Projection
Pathways in Carbohydrate Metabolism
- Glycolysis (Embden Meyerhof pathway)
- Glycogenesis
- Glycogenolysis
- Gluconeogenesis
Formation of the fatty
acid
lipogenesis
breakdown of fatty acid
lipolysis
Also known as EMBDEN MEYERHOF PATHWAY
Glycolysis
Occurs in the cytoplasm and involves the conversion
of glucose to pyruvate and the production of ATP and
NADH
glycolysis
Under anaerobic conditions, pyruvate can be
converted to ___ and this is important for muscle
tissue, which has no adequate oxygen supply.
lactate
glycolysis will convert GLUCOSE to ___
PYRUVATE
this pathway Produce ATP for cell’s energy
embden-meyerhof pathway
Formation of glucose to glycogen
Glycogenesis
Glycogenesis takes place in cytoplasm of___
liver and muscle
Glycogen is synthesized depending on the demand for
___
glucose and ATP
Process of ___ serves as built in mechanism
of the body which stores the excess carbohydrate we
consume in the form of glycogen which can be broken
down to glucose when needed
glycogenesis
Breakdown of glycogen to form GLUCOSE
Glycogenolysis
what are the hormones that promotes glycogenolysis
glucagon and epinephrine
what organ is producing the hormone glucagon
pancrease
what organ is producing the hormone epinephrine
adrenal glands
Formation of GLUCOSE from non-carbohydrate
sources
Gluconeogenesis
Gluconeogenesis occurs mainly in
liver
the process of gluconeogenesis is For glucose dependent organs (such as
brain and muscles)
a process wherein Substrates such as lactate, pyruvate, amino acids
and glycerol can be converted into glucose to
maintain normal glucose level in the blood (When low
in glucose)
gluconeogenesis
what is the starting point of gluconeogenesis
PYRUVIC ACID
example of the 3 carbon compound or trioses
glyceraldehyde
example of the 4 carbon compound or tetroses
erythrose
importance of the 5 carbon compound or pentose
important for nucleic acid and neurotransmitters of the brains
example of a hexose or a 6 carbon compound
glucose
example of a sugar that has a functional group of aldehyde
glyceraldehyde
example of a sugar that has a functional group of ketone
dihydroxyacetone and fructose
what do we called a bond for connecting 2 sugars?
glycosidic bonds
examples of polysaccharide - more than 10 polymers of sugars
starch
glycogen
cellulose
chitin
inulin
what are the reagents used to detect reducing sugars before?
benedict’s test
and fehling’s test
SALIVARY AMYLASE IS ALSO KWOWN AS
ptyalin hormone
prodcts of glycolysis
2 pyruvate
nadph
4 atp only 2 gains
in severe lack of ocgn or anaeroic respiration, they convert pyruvate into ___ through enzyme __
lactate or lactic acid tru lactate dehydrogenase
why do lactate test do not rewuire tourniquet
prolong tourniquet will introduce an anaerobic environment thus will increase the value of lactic acid –> falsely increase
where do glycolysis takes place?
cytoplasm
where do kreb’s’c cyle takes place?
mitochondria
byproduct of glycolysis
lactate
starting point of fatty acids
acetyl coa
byproduct of kreb’s cycle
ketone bodies
glucose transporter - that will absorvs glycose and galactose
sglt 1
glucose transporter that will take care of the fructose
glut 5
glucose transporter that will transport all the absorb glucose and fructose to the blood
GLUT 2
triglyceride is composed of
head and a tail
1 head - 1 molecule of glycerol
tail - 3 molecules of fatty acids
what is the source of ketone bodies
acetyl coa
relation of lipolysis to blood glucose
lipolysis or breakdown of fats means the blood glucose level is low or decreased,
the conversion of glucose into glucose 6 phosphate is done by the enzyme called
hexokinase
where does the 10% of metabolism takes place?
under the pathway, hexose monophosphate shunt
what is the end product of hexose monophosphate shunt
ribose 5 phosphate
nadh helps in
helps the rbc to form reduced gluthathione
helps in elimination of glutathione
helps rbc against reactive oxygen specie and super oxide dismutase
prtiects rbc membrane from degradation
low nadh will cause
intravascular hemolysis
a production or formation of glycogen in liver is done by what enzyme
glucokinase
a production or formation of glycogen in muscle is done by what enzyme
hexokinase
the major hyperglycemic agent
glucagon
the only hypoglycemic agent
insulin
pancreas works as an endocrine and exocrine gland
endocrin
exocrine
endocrine - directly to the blood
exocrine - needs glands and sacs to excrete
3 hormones that the pancrease secrete
insulin, glucagon, somastotin
pancreas as an exocrine gland , it will secrete
pancreatic amylase
it promotes the uptake if the glucose into the cell
insulin
the primary hormone responsible for the entry of the cell
insulin
where do we store insulin
liver, fat , and muscles
Serum insulin measurements may be falsely low in
the presence of ___.
hemolysis
It is synthesized by the a-cells of the islets of
Langerhans in the pancreas.
Glucagon
Fasting plasma glucagon concentrations is normally
25-50 pg/mL.
It is released during stress and fasting states.
Glucagon
These are secreted by the cells of the zona
fasciculata and zona reticularis of the adrenal
cortex.
Cortisol and corticosteroids (Glucocorticosteroids)
They decreased intestinal entry of glucose into the
cell.
Cortisol and corticosteroids (Glucocorticosteroids)
Cortisol and corticosteroids (Glucocorticosteroids)
They promote __ and __.
gluconeogenesis and lipolysis
These are released from the chromaffin cells of the
adrenal medulla (middle of adrenal glands)
Catecholamines
they Inhibit insulin secretion and promotes
glycogenolysis and lipolysis.
Catecholamines
It is secreted by the anterior pituitary gland.
Growth hormone (Somatotrophic)
It decreases entry of glucose into the cell.
Growth hormone (Somatotrophic)
Growth hormone (Somatotrophic)
It promotes ___ and ___.
glycogenolysis and glycolysis
It promotes glycogenolysis, gluconeogenesis and
intestinal absorption of glucose.
Thyroid hormone
It stimulates release of cortisol from the adrenal
cortex.
Adrenocorticotropic hormone (ACTH)
Adrenocorticotropic hormone (ACTH)
It promotes __- and ___
glycogenolysis and gluconeogenesis.
It is produced by the delta cells of the islets of
Langerhans of the pancreas.
Somatostatin
It is also synthesized in the paraventricular and
arcuate nuclei of the hypothalamic neuroendocrine
hormone
Somatostatin
Somatostatin
It primarily inhibits the action of __
of insulin, growth
hormone and glucagon
It is an increase in blood glucose concentration.
Hyperglycemia
It is toxic to beta cell function and impairs insulin
secretion
Hyperglycemia
problem in corticosteroids has a common disease called
cushing’s disease
Laboratory Findings in Hyperglycemia
- Increase urine specific gravity
- Ketones in serum and urine
- Decrease blood and urine pH (acidosis)
- Electrolyte imbalance ( Na+, K+, HCO3)
a normal fbs glucose level
70-99 mg/dl - book basd
>126 - stan bio
100 - 105 mg/dl in fbs is considred
impaired
> 126 mg/dl is
diabetic
3important ketone bodies
b-hydroxybutiric acid 78%
acetoacetate 20%
acetone 2%
acetoacetate is used to be measured using
gerhardt’s - colored red
to detect acetone, we add ___ in gerhard’ts
glycerin
how to measure b-hydroxybutyric acid
use enzymatic method
in electrolyte imbalance caused by hyperglycemia, which electrolytes increase and decreases?
Na and HCo3 decrease
potassium increase
type of diabetes has increase ketone?
tpe 1 DM
A diagnosis of hypoglycemia should not be made
unless a patient meets the criteria of ___
Whipple’s triad
Can cause comatose
hypoglycemia
Whipple’s triad is a collection of three criteria (called
Whipple’s criteria)
- Symptoms known or likely to be caused by
hypoglycemia especially after fasting to an
external site. or heavy exercise - A low plasma glucose measured at the time of the symptoms
- Relief of symptoms when the glucose level is
raised
range glucagon and other glycemic
hormones are released into the circulation
65mg/dL to 70mg/dL
- strongly suggest hypoglycemia (series of
random fasting serum specimens)
<60 mg/dl
observable symptoms of
hypoglycemia appear
50mg/dl to 55 mg/dl
A blood glucose level ___ in
infants is considered abnormal and requires
diagnostic assessment.
50 mg/dL (2.8 mmol/L)
Symptoms of Hypoglycemia
Neurogenic
Neuroglycopenic
Neurogenic Symptoms of Hypoglycemia
tremors, palpitations, anxiety,
diaphoresis
Neuroglycopenic Symptoms of Hypoglycemia
dizziness, tingling, blurred vision,
confusion, behavioral changes
Classification of Hypoglycemia
Drug administration
Critical illnesses
Hormonal deficiency
Endogenous hyperinsulinism
Autoimmune hypoglycemia
Non-beta cell tumors
Hypoglycemia of infancy and childhood
Alimentary (reactive) hypoglycemia
Idiopathic
a 5 hr glucose tolerance test is suggested to observe the hypoglycemic “___” which is often not seen until after 3 hrs
dip
determines fasting hypoglycemia with blood samples drawn at 2 mns to 2 hrs interval (6 specimens) to measure glucose and insulin
tolbutamide tolerance test
determines reactive hypoglycemia by measuring the response of insulin to a cocktail mean, which is a mixture of carbohydrates, proteins, and fats,
mixed meal tolerance test
mixed meal tolerance test will drawn sample at ___ MNS
15, 30, 45, 60, 90, and 120 minutes
in the traditional diagnostic test for hypoglycemia, blood should be drawn every __- hrs to measure glucose, c peptide, insulin, and pro insulin, and ketone bodies
6 hrs
in traditional diagnostic test for hypoglycemia, the fasting procedure must be stopped if the plasma glucose level decreases to less than ___
45 mg/dl
how alcohol decrease glucose
alcohol inhibit hepatic gluconeogenesis
increase glycogen phosphorylase activity
alimentary (reactive) hypoglycemia occurs usually within how many hrs after eating a meal
4 hrs after eating a meal
alimentary or reactive hypoglycemia is formerly known as
postprandial hypoglycemia
fasting hypoglycemia is previously called as
postabsorptive hypoglycemia
the intentional attempt to induce low blood glucose levels
factitious hypoglycemia
results from exogenous self administration of insulin or insulin secretagogues medications
factitious hypoglycemia
a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, receptors, or both
DM
fasting plasma glucose concentration of more than 126 mg/dl on more than one testing is a diagnostic of
DM
the presence of ___ is a frequent finding in individuals with severe, uncontrolled diabetes
ketone bodies
it develops in DMA from excessive synthesis of acetyl-CoA, as the body attemps to obtain required energy from stored fat in the absence of an adequate carbs metabolites
ketosis
since si glucose di nagagamit for cells, ang gagamitin ni body is fats
in DM, what is the ratio of b-hydroxybutyrate to acetoacetate
6:1
the entire process of ketosis can be reversed by
insulin administration
in the presence of normal renal function, plasma glucose “period of plateau” that is around ___, that is, the renal excretion will match the overproduction casing the plateau
300 mg/dl - 500 mg/dl
electrolyte that will increase in DM due to acidosis caused by ketoacidosis
potassium = hyperkalemia
type 1 DM former names
insulin dependent DM
juvenile onset DMA
brittle diabetes
ketosis-prone diabetes
result of cellular-mediated autoimmune destruction of the b cells of the pancreas
type 1 dm
type of DM that has insulinopenia (absolute insulin deficiency ) due to loss of pancreatic b cells
which will make the patient depend in the insulin to sustain life and prevent ketosis
type 1 dm
how many percent of reduction in the volume of the b cell in pancreas is required to induce symptomatic type 1 DM
80-90%
which means only after most of the beta cells are destroyed that hyperglycemia develops
individuals with type 1 dm have high titers of ___
multiple autoantibodies such as
glutamic acid decarboxylase (GAD65)
and insulin autoantibodies (IAA)
among the multiple autoantibodies for patients with type 1 dm
which one is more common in young children
insulin autoantibodies
among the multiple autoantibodies for patients with type 1 dm
which one is more common in adults
glutamic acid decarboxylase
this form of type 1 dm has no known etiology, and is strongly inherited
idiopathic type 1 dm
describe as type 1a or 1.5 DM
latent autoimmune diabetes of adulthood (LADA )
referred to as the slow immune-mediated DM or the slowly progressive insulin-dependent type 1 DM
LADA
also known as the fulminant type 1 dm
idiopathic dm
or type type 1b dm
characterized by rapid and complete b cell destruction
idiopathic type 1b dm
subset of type 1 dm with aggressive progression of hyperglycemia and ketoacidosis
idiopathic type 1 dm
type 2 dm is also known as
non insulin dependent dm
adult type/maturity onset diabetes mellitus
stable diabetes
ketosis-resistant diabetes
receptor-deficient diabetes mellitus
describe as the hyperglycemia due to an individual’s resistance to insulin with defective insulin secretion
type 2 dm
described as a geneticist’s nightmare
type 2 dm
type of dm with strong genetic predisposition and not usually related to an autoimmune disease
type 2 dm
difference of complication of type 1 and 2 dm
type 1 dm = microvascular complication
type 2 dm = macrovascular complication and microvascular complication
it is recommended that adults at age of ___ and older must be screened for DM every 3 yrs
45
the screening and diagnosis of GDM is through
2 hr ogtt
diagnostic criteria for GDM is
FBS - > 92mg/dl
1 hr sample gct - 180/mg/dl
2 hr sample - 153mg/dl
also known as the type 3c DM
pancreatogenic diabetis mellitus
it develops as an outcome of a pancreatic disease such as chronic pancreatitis or carcinoma
type 3 dm
type 3c is characterized by
insulin deficiency and loss of pancreatic polypeptide
the standard clinical specimen for glucose is
venous plasma glucose
fasting whole blood is 10 - 15% lower than the fasting serum or plasma because of
dilution
a serum sample for glucose is appropriate for glucose testing within 30 mns, if not, what preservative must be added to prevent glycolysis
sodium fluoride
venous blood glucose is __- lower than the capillary blood due t0 ___
-2-5 mg/dl due to tissue metabolism
csf glucose presentation should be ___ % of the plasma concentration
60%
peritoneal plasma glucose level compared to plasma glucose level
the same
at room temp 20-25*C, glycolysis decreases glucose by ____ in normal uncentrifued coagulated blood
7mg/dl/hr
at refrigerated temp 4*C, glycolysis decreases glucose by ____
glucose is metabolized at the rate of about 2 mg/dl/hr
effect of leukemia to glucose testing
leukemia tend to increase glycolysis
causing false decrease
in samples without contamination and leukocytosis the sample is clinically acceptable even after a delay up to ___ before separation of serum and cells
90 mns
8 hrs in 25C
72 hrs in 4C
the sample for blood glucose should be drawn at least how many minutes before the lumbar puncture
60 mns
for better correlation with fasting plasma glucose and clinical interpretation, csf should be collected after __ hrs of fasting
4-6 hrs
what are the chemical method for glucose determination
alkaline copper reduction method
alkaline ferric reduction method
methods under the alkaline copper reduction method
folin wi
nelson somogyi
neocuproine (2,9 dimethyl 1,10 phenantroline hydrochloride)
benedict’s method
method under alkaline copper reduction method
that is the modification of folin wu
benedict’s method
under alkaline copper reduction method
explain the process
alkaline copper tartrate –> glucose and heat –> cuprous ions
what is added in folin wu to detect glucose
cuprous ions + phosphomolybdate
= phosphomolybdic acid or phosphomolybdenum blue
what is added in nelson-somogyi to detect glucose
cuprous ions + arsenomolybdate
= arsenomolybdic acid or arsenomolybdenum blue
among the alkaline copper reduction method which one is the most accurate but labor intensive and difficult to automate
nelson-somogyi
what is added in neocuproine to detect glucose
cuprous ions + neocuproine
= cuprous-neocuproine complex (yellow or yellow orange complex)
an alkalin reduction method that is used for the detection and quantitation of reducing substances in body fluids like blood and urine
benedict’s method
stailizing agent of benedict’s method
citrate or tartrate
it involves reduction of a yellow ferricyanide to a colorless ferrocyanide by glucose
alkaline ferric reduction method (hagedorn-jensen)
condensation method of glucose determination
ortho-toluidine
ortho-toluidine is also k=called as
dubowski method
end color for dubowski method
green
it measures b-d glucose
colorimetric glucose oxidase method
colorimetric glucose oxidase method is also called as
trinder
colorimetric glucose oxidase method or trinder contains what enzyme reagent
mutarotase enzyme reagent
inhibitors of colorimetric glucose oxidase method
ascorbic acid
bilirubin
creatinine
uric acid
l dopa drug
measures the rate of oxygen consumption which is proportional to glucose concentration
polarographic glucose oxidase method
glucose oxidase in the reagent catalyzes h\the oxidation of glucose by oxygen under first order conditions, forming hydrogen peroxide
polarographic glucose oxidase method
in polarographic glucose oxidase method
hydrogen peroxide is prevented from reforming oxygen by adding
molybdate, iodide, catalase, or ethanol
the enzymatic conversion of glucose is quantitated by the consumption of oxygen on an oxygen-sensing electrode
polarographic glucose oxidase method
purpose of catalase in polarographic glucose oxidase method
inhibits reversible movement of hydrogen peroxide back to the sample chamber that may cause interference analysis
is the most specific enzymatic method for glucose determination
hexokinase method
routine method for measurement of glucose
hexokinase method
hexokinase method
plasma collected using what AG
heparin, edta, fluoride, oxalate, citrate
in hexokinase method, the G-6-PD in the reagent is derived usually from
yeast
the presence of bleach in the glucose oxidase method can cause __
false increase of glucose
hexokinase method is measured in spectrophotometer at __nm
340
hexokinase method depends on the reduction of __ at 340 nm
NAD to NADH
in this method, glucose is reduced to produce CHROMOPHORE that is measured spectrophotometrically or with the use of an electrical current
glucose dehydrogenase method
it provides results in close agreement with the hexokinase procedure
glucose dehydrogenase method
in glucose dehydrogenase method, what is the purpose of MTT or mutarotase
to shorten the time necessary to reach equilibrium
mtt or mutarotase is the dye chemically known as
3,(4-5-dimethy-thiazol-2-yl)- 2-5-diphenyltetrazolium bromide
this procedure is less affected by anticoagulants and indigenous analytes in plasma
glucose dehydrogenase method
causes of false decreased plasma glucose level in glucose oxidase method
ascorbic acid
bilirubin
uric acid
gluthathione
creatinine
l cysteine
l dopa
dopamine
methyldopa
citric acid
how hemolysis affects hexokinase method
false decrease of plasma glucose
effect of lipemia and icteresia in hexokinase method
positive interferences - falsely increase
hexokinase method is not affected by
ascorbic acid or uric acid only glucose oxidase method
it is important in establishing correct insulin amount for the next dose
dextrostics (cellular strip)
effective in reducing the rate of development of diabetic complications
dextrostics (cellular strips )
measuring device for continuous monitoring of glucose in persons with DM
interstitial glucose measuring device
this glucose trend analysis can reveal useful findings for modifying treatment, such as unsuspected nocturnal hypoglycemia or postprandial hyperglycemia
interstitial glucose measuring device
sample for glucose measurement that is requested during insulin shock and hyperglycemic ketonic coma
random blood sugar
a measure of overall glucose homeostasis
fasting blood sugar
when glucose is used to diagnose diabetes, the guideline recommends it to
measured in venous plasma in an accredited laboratory
requirement for fasting blood sugar
at least 8 hrs prior to sample collection - NPO
fbs non DM values
70-99 mg/dl
fbs DM values
> 126mg/dl
characterized by fasting blood glucose concentration between normal and diabetic values
impaired fasting glucose 100-125 mg/dl
for children, the plasma glucose concentration for non diabetic is
60-100 mg/dl
it measures the response of the body to a full meal
2 hr post prandial blood sugar
it measures how the body metabolize glucose
2 hr postprandial blood sugar
non dm for 2 hr postprandial
<140 mg/dl
dm for 2hr post prandial
> 140 mg/dl
a multiple blood sugar test
glucose tolerance test
used to determine how well the body metabolizes glucose over a period of time
gtt
aids in the diagnosis of gestational DM and cystic fibrosis related DM
GTT
2 kinds of glucose tolerance test
oral and intravenous
types of oral glucose tolerance test
janney-isaacson method - single dose method
exton rose method - divided or double dose method
si janney single, si rose hindi
plasma glucose level after intake of glucose load
in 30 mns
30-60 mg/dl above fasting
plasma glucose level after intake of glucose load
in 1 hr
20-50 mg/dl above fasting
plasma glucose level after intake of glucose load
in 2 hrs
5-15 mg/dl above fasting
plasma glucose level after intake of glucose load
in 3 hr
fasting level or below
it is recommended for DM patients with gastrointestinal disorders
intravenous glucose tolerance tets
sample required for intravenous glucose tolerance test
fasting blood sample
glucose load of ___ g per kg of body weight is required for intravenous glucose tolerance test
0.5 g, administered intravenously within 3 mns
the second blood collection in IVGTT is
after 5 mns of IV glucose
indications of IVGTT -
conditions when we should only administer IVGTT
unable to tolerate large carbohydrate load
with altered gastric physiology
post gastric surgery
with chronic malabsorption syndrome
requirements for OGTT
patient should be ambulatory
unrestricted diet of 150 grams of carbs/day for 3 days to testing
fasting 8-14 hrs
glucose load
- standard of 75 grams
- 1.75 g per kg for children , max of 75 grams
- additional 100 grams for 2 step OGTT
the patient must drink the glucose load within how many minutes for OGTT
5 mns
conversion factor for blood glucose level mg/dl to mmol/L is
0.0555
the glucose concentration in 24 hr urine is about
1-15 mg/dl
HbA1c is also known as
glycosylated hemoglobin
glycated hemoglobin
a stable ketoamine and a product of a covalent reaction between glucose and the a-amino group of the b-chain of hemoglobin
glycosylated hemoglobin
how HbA1c is formed
from the non enzymatic reaction between the glucose and the n-terminal end of the b chain of hemoglobin
producing a schiff base which is then converted into amadori products such as the HbA1c
it is the large subfraction of normal hemoglobin A in both diabetic and non diabetic individuals
HbA1c
it represents a weighted average of glucose levels, with the youngest red blood cells contributing to the measurement
glycosylated hemoglobin HbA1c
it monitors long-term glucose control or treatment of DM
HbA1cq
it reflects the average blood glucose level over the previous 2-4 months
hba1c
is Diet has an effect to Hba1c measurement
naur, dietary status on the day of the test has no effect on hba1c
specimen for HbA1c
edta whole blood
interferences in HbA1c
alcohol
vitamins - retinol and ascorbate
drugs - salicylates and opiates
carbamylated, abnormal hemoglobins
normal HbA1c
<5.7%
impaired HbA1c
5.7% - 6.4%
DM HbA1c
> or = 6.5 % at least on 2 occasions
HbA1c false decreased
shortened rbc survial
hemolytic anemia
recent blood transfusion
recovery from acute blood loss
hemoglobinopathies
chronic liver disease
hypertriglyceridemia
use of antimicrobials
vitamins c and e
poisoning due to salicylates and lead
for every 1% change in HbA1c how many glucose is added to plasma
35 mg/dl
diagnostic criteria for DM
fbs >= 126 mg/dl
2hr ogtt => 200 mg/dl
hba1c >= 6.5 %
pwede rin rbs reaching >200mg/dl as an adjunct marker to consider DM
reflection of short term glucose control over a period of 2-3 weeks
fructosamine
useful in monitoring diabetic individuals with chronic hemolytic anemia, hemoglobin variants and those individuals with dcreased rbc lifespan disorders
fructosamine
fructosamine should not be measured in cases of low plasma __
albumin
fructosamine is mostly composed of
glycosylated or glycated albumin; remaning portions are globulins and lipoproteins
it determines glycemic control earlier than fructosamine
1,5 anhydroglucitol
reflects 1-2 weeks postprandial glycemia
1,5 anhydroglucitol
it has low level in the presence of hyperglycemia
1,5 anhydroglucitol
a congenital deficiency of one of three enzymes involved in galactose metabolism
galactosemia
galactosemia has 3 enzymes involved
galactose - 1 - phosphate uridyl transferase
galactokinase
uridine diphosphate galactose 4 epimerase
a csf glucose level of __ is considered abnormal
<40 mg/dl
markedly decrease CSF glucose with leukocytosis means
bacterial meningitis
a medical condition characterized by sterile meningitis that usually develops in certain patients after neurosurgical procedures
chemical meningitis
is formed during the conversion of pro insulin to insulin
c peptide
mainky evaluates hypogycemia and continuous assessment of b cell function
c peptide
is recommended when plasma glucose reached 300 mg/dl
ketone test
the normal ratio of b hydroxybutyrate and acetoacetic acid is
1:1
it deetermines the endogenous insulin secretion in type 1 dm
mixed meal tolerance test
measures glucose tolerance in response to a meal induced hyperglycemia
mixed meal tolerance test
an increase in acetone is indicative of a defect in the metabolism of
carbohydrtaes
gerhardt’s ferric chloride test reacts only with
acetoacetate
nitroprusside test is __ more sensitive to
10x more sensitive to acetoacetate than to acetone
acetest tablest
detects acetoacetate and acetone (lesser degree )
