PART 1 Flashcards
What is the most common non-reducing sugar
Sucrose
Sucrose does not have an aldehyde or ketone group. Thus,
making it a non-reducing sugar.
Simplest CHO:
Glyceraldehyde
Structural properties of Carbohydrates
- Size of the base carbon chain
- Location of the CO function group
- Number of Sugar Units
- Stereochemistry of the compounds
- Pertains to beta and alpha configuration
- Appearance of carbohydrate
- Fischer or haworth projection *no recall
from boards
All sugars must be digested to this monosaccharide.
Carbohydrates
Serves as major source of energy for the body
Carbohydrates
Sugar that contains 3, 4, 5, 6 carbon atoms (triose, tetroses, pentoses and hexoses, etc.)
Monosaccharide
Glucose is the only monosaccharide used by the body for energy
Carbohydrates
Sugar that cannot be hydrolyzed to a simpler form
Monosaccharide
end product of CHO digestion is:
Glucose
energy mediator of oxidation of glucose is:
ATP (Adenosine Triphosphate)
glucose + glucose:
Maltose; Maltase
Formed by interaction of two monosaccharides; separated by hydrolysis
Disaccharides
glucose + galactose
Lactose; Lactase
glucose + fructose:
Sucrose; Sucrase
What organs produce maltose, lactose, and sucrose
Pancreas
Remedy for constipation
Soluble fibers
<10 - >2 monosaccharides (Soluble fibers)
Oligosaccharides
Linkage of many monosaccharide units ; linked by glycosidic bond
polysaccharides
Include starch (known polysaccharide), glycogen & cellulose
Polysaccharides
What is the immediate product of starch in hydrolysis?
A. Glucose
B. Maltose
C. Sucrose
D. Lactose
B.Maltose. The enzyme responsible is amylase. When the maltose is hydrolyzed by maltase, you will produce two molecules of glucose. Marami nagkakamali dito
because initially they answered glucose instead of maltose.
Final hydrolysis
Small Intestine
Metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both
DIABETES MELLITUS
In severe DM the ratio of B-hydroxybutyrate to acetoacetate is ___
6.1
Pathogenesis
β-cell destruction
TYPE 1 (IDDM
Onset
Childhood/teens
TYPE 1 (IDDM
Incidence rate
10-15%
TYPE 1 (IDDM
Risk factors
Genetic, autoimmune
TYPE 1 (IDDM
Hyperglycemic
G
A
G
C
H
E
T
G - Glucagon
A - ACTH
G - Growth Hormone
C - Cortisol
H - Human Placental Lactogen
E - Epinephrine
T - Thyroxine
Symptom
Abrupt
TYPE 1 (IDDM
C-peptide level
Undetectable
TYPE 1 (IDDM
Pre-diabetes
Autoantibodies (+)
TYPE 1 (IDDM
ketosis
Common, poorly controlled
TYPE 1 (IDDM
Medication
Insulin absolute
TYPE 1 (IDDM
Hypoglycemic
Insulin
Lack of insulin results to:
a. Impaired entry of glucose into the cell
b. Increased glucose uptake by the cell
c. Islet hyperplasia
d. Decreased plasma glucose
e. Increased production of proinsulin
A. Impaired entry of glucose into the cell
Hydrolysis of lactose by lactose by lactase will yield:
a. 2 molecules
b. Glucose and fructose
c. Glucose and galactose
d. Galactose and fructose
C. GLUCOSE AND GALACTOSE
Starch is hydrolyzed by amylase to produce what immediate product?
a. Glycogen
b. Maltose
c. Glucose
d. lactose
B. MALTOSE
The process of glucose-6-phosphate formation from a
non-carbohydrate source is called:
a. Glycogenolysis
b. Glycolysis
c. Gluconeogenesis
d. Glycogenesis
e. lipogenesis
C. Gluconeogenesis
Hypoglycemic action of insulin regulates glucose by increasing:
I. Glycogenolysis
II. Lipogenesis
III. Glycolysis
a. I only
b. II only
c. I and II
d. II and III
e. I, II, and III
D. II and III
The primary hyperglycemic hormone released by the adrenal gland is/are:
a. Epinephrine
b. Cortisol
c. Glucagon
d. A and B
e. A, B, and C
D. A and B
Rationale: Glucagon is in the pancreas specifically, alpha. Because epinephrine is in renal medulla while cortisol is in
adrenal medulla
Which inhibit growth hormone secretion?
A. Glucose loading
b. amino acids
c. Thyroxine deficiency
d. Insulin deficiency
A. Glucose loading
When you give glucose to a patient. growth hormone should be suppressed. In times that it isn’t suppressed, patient has
acromegaly or gigantism. This is caused by excessive growth hormone. Normally, when
the glucose is high, growth hormone is decreased.
What is the renal threshold of blood glucose (Range)
160 - 180 mg/dL (Elsevier)
Glucose in the urine
Glucosuria
What is the formula of Osmolality?
Osmolality = 2 (Na+ + K+) + Glucose/18/20 + BUN/ 2.8/3.0
Glucose intolerance during pregnancy
Gestational
When you lose water in the body, what electrolyte is loss?
Sodium
o ___ Step Approach: 2 HPPG with 75 g
o ___ Step Approach: if POSITIVE (1 HHPG> 140mg/dL) -OGTT
o One Step Approach: 2 HPPG with 75 g
o Two Step Approach: if POSITIVE (1 HHPG> 140 mg/dL) -OGTT
Due to metabolic and hormonal changes
GESTATIONAL
Normal value of Sodium
135- 145
FBS 3 hour OGTT(100g)
Gestational
Gestational
OGTT Screening: ______________.
24-28 weeks
(going to third trimester)
Repeat testing after delivery: _______________
6-12 weeks after
delivery
cut-off value for hypoglycemia
<70 mg/dl
↓ glucose in plasma
HYPOGLYCEMIA
– observable symptoms of hypoglycemia may occur
50-55 mg/dl
What is the function of
Aldosterone?
○ Responsible for sodium reabsorption
○ Promotes potassium deficiency
○ Even when you reabsorb a minute amount of potassium, dehydration still occurs because
of frequent urination. Patient will have hypokalemia
release of glucagon
65-70 mg/dl
What electrolyte deficiency leads to cardiac arrest?
Potassium
Reduction of cupric ions to cuprous ions forming cuprous oxide in hot alkaline solution by glucose
ALKALINE COPPER REDUCTION METHOD
Chemical method that utilizes the nonspecific reducing property of glucose
ALKALINE COPPER REDUCTION METHOD
Breakdown of fats
Lipolysis
Other name of Type 1 (IDDM)
Juvenile Onset
Brittle DM
Ketosis prone
Which Statements refer to Type 1 Diabetes?
a. Results from B-cell destruction and usually diagnosed in children
b. Results from B-cell destruction, usually leads to absolute insulin deficiency and usually diagnosed
in children
c. Usually leads to absolute insulin deficiency and usually diagnosed in children
d. Results from B-cell destruction and usually leads to absolute insulin deficiency
b. Results from B-cell destruction, usually leads to absolute insulin deficiency and usually diagnosed
in children
Which refers to Type I Diabetes?
1, 2, and 3
Central Obesity
Insulin Resistance
Other name of Type 2 (IDDM)
- Adult Type
- Maturity Onset
- Stable Diabetes
- Ketosis resistant
- Receptor Deficient DM
24.9 -
25 - 29.9 -
>30 -
24.9 - Normal
25 - 29.9 - Overweight
>30 - Obese
is controlled often without insulin replacement
Hyperglycemia (Type II DM)
How do you know if your obese?
BMI = wt(kgs)/ht(m^2)
Hyperosmolar Hyperglucemic Nonketotic Syndrome is more common among individuals with:
a. Type 1 DM
b. Type 2 DM
c. Gestational DM
d. A and B
e. A, B, and C
b. Type 2 DM
Characteristics of Type 2 DM, Except:
a. Obesity and Unhealthy lifestyle are major risk factors
b. Detectable C-peptide
c. Autoantibody positive
d. Hyperglycemia is controlled without insulin
c. Autoantibody positive
According to American Diabetes Association, risk factors for DM include all of he following EXCEPT:
a. History of Gestational Diabetes Mellitus in women
b. Elevated triglyceride concentrations of >250 mg/dL
c. Women with Polycystic Ovarian Syndrome
d. BMI of greater than >25.0 kg/m2
e. Frequent urination at night
e. Frequent urination at night
Which does not refer to IDDM?
a. Age of onset-usually before 20 years of age
b. Serum insulin - very low
c. Presence of ketone dodies - usually
d. None of the items
D. None of the items
Whipple’s Triad
- Glucose <45mg/dL
- Symptoms of Hypoglycemia
- Resolution of symptoms after glucose administration
Copper reduction method (uses BaSO4 to remove saccharoids)
Nelson-Somogyi
Glucose/cuprous ions + phosphomolybdate—-.phosphomolybdic acid or
phosphomolybdenum blue
Folin-Wu
Cuprous ions + neocuproine—–à cuprous neocuproine complex(yellow/yellow orange)
Neocuproine
Glucose + ferricyanide (yellow) à ferrocyanide (colorless)
Hagedorn-Jensen
Detection, & quantitation of reducing subs in body fluids like blood and urine.
Use citrate or tartrate as stabilizing agent
Benedicts mtd
Ferric reduction method (inverse colorimetry)
Hagedorn-Jensen
Condensation of carbohydrates with aromatic amines producing Schiff bases (green)
Dubowski/O-toluidine method
Glucose/cuprous ions + arsenomolybdic avid à arsenomolybdenum blue
Nelson-Somogyi
(Saifer Gernstenfield)
GLUCOSE OXIDASE
Coupled Enzyme Reaction (Trinder’s Reaction) - colorimetric
GLUCOSE OXIDASE
Used only for CSF but not
urine because it contains
interferences in peroxidase reaction
GLUCOSE OXIDASE
2 common enzymatic method
- Glucose Oxidase
- Hexokinase
β-D-glucose + O2 +H2O –_____________ -> gluconic acid + H2O2
Glucose oxidase
H2O2 + reduce chromogen (o- Dianisidine) –-__________-> oxidized (o-Dianisidine)
chromogen – red dye+ H2O
Peroxidase
Subject to interference by: uric acid, bilirubin, ascorbic acid
GLUCOSE OXIDASE
What is the Coupling enzyme of???
Peroxidase
Less common than hexokinase method. Commonly used for glucose meter testing.
Accurate and precise method virtually no interferences
Glucose oxidase – O2 Consumption
For urine and whole blood glucose rapid reagent strip testing. Also used for
automated methods for plasma and serum
GLUCOSE OXIDASE
β-D-glucose + O2 +H2O –glucose oxidaseà gluconic acid + H2O2
(O2 consumption is measured by O2 electrode)
Glucose oxidase – O2
Consumption
conversion of glucose is quantitated by consumption of oxygen (electrode)
Polarographic Glucose Oxidase Method
Glucose + ATP – __________ -> glucose 6-PO4 + ADP
hexokinase
More accurate than glucose oxidase
Hexokinase
Most specific and reference method
HEXOKINASE
Glucose 6-PO4 + NADP+ –__________ -> NADPH + H+ + 6-phosphogluconate
G-6-PD
Based on formation of NADH followed by increase in absorbance at 340 nm (directly
proportional to glucose concentration
HEXOKINASE
Falsely low result is due to: Elevated Ascorbic Acid , UA ,Creatinine and Hemolysis
inhibits peroxidase
HEXOKINASE
Specific glucose method which employs G6PD as a second coupling step requiring
___________
Magnesium (Activator)
In Hexokinase, glucose is measured by?
a. Rate of NADPH
b. Formation of Oxidized dye
c. Reduction of Cupric to Cuprous
d. Rate of Oxygen disappearance measured by electrode
a. Rate of NADPH
In Glucose Oxidase Method, the coupling enzyme used
to catalyze oxidation of the dye by is 𝐻2𝑂2 is:
a. Glucose Oxidase
b. hexokinase
c. Glucose-6-Phosphate Dehydrogenase
d. Peroxidase
e. Glucose Dehydrogenase
d. Peroxidase
Glucose measurement using the reducing substances approach may be erroneously higher by ___ mg/dL compared to the enzymatic method
a. 5 - 15
b. 25 - 30
c. 15 - 25
d. 10 - 20
A. 5-15
What is the values of 200mg/dL glucose in mmol/L?
● 8.5
● 10.50
● 11.0
● 13.75
C. 11.0
Rationale: 200 x 0.0555 = 11 because 0.0555 is the conversion factor of glucose from mmol/L to mg/dL
In aerobic pathway, 1 glucose yields final ___ ATP
2
This is formed by hydrogen bonds; hydrolases are the
enzymes that cuts these bonds
DISACCHARIDE
Carbohydrates has two functional group:
ketone and aldehyde derivative
The known structural formula of carbohydrates is _____________
(C6H12O6)
All carbohydrate are ___________ because of the availability of ketone and aldehyde
Reducing sugar
If these two functional groups are not present, the sugar is a _____________ sugar (ex. Sucrose)
Non-reducing
The most common non-reducing sugar is
Sucrose
No aldehyde or ketone
is measured through its capacity to reduce sugar (using non-enzymatic methods such as
Nelson-Somogyi)
Glucose
What is the simplest carbohydrate?
glyceraldehyde
two to ten sugar molecules
OLIGOSACCHARIDES
condition when body lacks lactase; unable to process lactose
Lactose intolerance
soluble fiber which is a remedy for constipation
○ Ex: chia seeds, psyllium fiber
○ Excessive intake of soluble fiber leads to flatulence
OLIGOSACCHARIDES
How can you know if you lack fiber?
If your poop is not floating. The poop should be floating pero buo dapat
What is the product of hydrolysis of maltose?
Glucose + Glucose
● mechanical digestion = chewing and swallowing
● chemical digestion of carbohydrate
● salivary amylase is present here
● Ex: Kamote (polysaccharide)
Mouth
● mechanical digestion, chemical digestion, absorption
of lipids to soluble substances
● Kamote will become disaccharide
Stomach
releases the necessary enzymes
Pancreas
● final digestion and absorption happens
● Kamote should be monosaccharide in here
○ The bloodstream will not absorb if its in
disaccharide form
Small intestine
● no chemical digestion
● Absorption of amino acids, glucose, lipids, water,
minerals, vitamins in large intestine
Large intestine
If you are having diarrhea, you are having malabsorption leads to dehydration and other
conditions
Large intestine
If you eat, it takes around ______ hrs for digestion which increases
the glucose, the pancreas will _________the insulin.
1-3; increase
The blood sugar is normal to be high if you ate ___ postprandial blood sugar.
2hr
The blood sugar should be less than _______mg/dl (normal). It’s normal to have hyperglycemia after you eat.
140
> 140-200 mg/dl =
impaired tolerance
The insulin will promote two
major processes glucose to glycogen =
glycogenosis
If glucose to fatty acids =
lipogenesis
________ will do everything so that your sugar will not
increase
Insulin
Who’s responsible for why people have bilbil or tumataba?
It is because of insulin. If the glucose gets normal, the insulin will stop the production
Primary hyperglycemic hormones
produced by the pancreas
Glucagon
Released by the anterior pituitary
gland that influences cortisol
ACTH
Hyperglycemic hormone released
by anterior pituitary gland
Growth hormone
Stress hormones
Cortisol
● Responsible for why pregnant
women is at risk of GDM
● Promotes insulin resistance among pregnant women
Human placental lactogen
OGTT in pregnant women because they are prone to have gestational diabetes mellitus (cause darkening different parts of the body)
Human placental lactogen
Adrenal medulla
Epinephrine
T4
Thyroxine
The glucose goes to the red cell, from the extracellular fluid going inside the intracellular basically, the _________ promotes or transports your glucose inside the red blood cell.
insulin
The problem starts with two mechanisms
First, lack/absence of insulin (type1 diabetes mellitus).
Other; lack of insulin or problem in insulin receptor (type II diabetes mellitus)
1st step in all pathways is glucose is converted to glucose-6 phosphate using ATP-catalyzed by ___________
hexokinase
(3) Glucose-6-phosphate enters the pathways:
- Embden-Meyerhof (glucose→pyruvate)
- Hexose monophosphate
- Glucogenesis
reference method for enzymatic method for glucose determination
hexokinase
storage of glucose as glycogen
Glucogenesis
Only hypoglycemic hormone?
Insulin
What are the hyperglycemic hormones?/ What are the hormones that regulate glucose metabolism? (GAGCHET)
Glucagon, ACTH, Growth hormones, Cortisol, Human Placental Lactogen, Epinephrine, Thyroxine
What is type 3C diabetes?
It is a post complication of pancreatitis
happens when glucose cannot
enter the red cell
Intracellular Hypoglycemia
■ happens when glucose increases
outside the red cell
■ there is increased levels of glucose
Extracellular Hyperglycemia
● Increased levels of glucose outside the red cell
EXTRACELLULAR HYPERGLYCEMIA
● Blood glucose will be greater than the renal threshold
EXTRACELLULAR HYPERGLYCEMIA
In patients seen with diabetes, there is an increased ___________ and __________ in the urine
specific gravity and osmolality
Osmolality =
275 - 295 mOsm/kg
__________= mOsm/kg
__________ = mOsm/L
Osmolality
Osmolarity
Ultrafiltrate of plasma is the
Urine
If glucose in blood is increased, then flows to the kidneys, it will cause
glucosuria
Too much urination =
polyuria
________ - counter balance
________ - counter ion
Potassium; Chloride
What is the normal urine output?
1200-1500 mL (greater than
will cause polyuria)
What is the condition when the patient frequently urinates with increased glucose and osmolality?
Osmotic diuresis
● Causes a decrease in sodium
Sodium is a cation, what is the counter ion of sodium?
Chloride or Bicarbonate
What is reabsorbed when sodium is excreted?
Potassium is a counter balance
PI-SO (happens when urinating)
Potassium In
Sodium Out
Normal value of Sodium
135-145
Value for Hyponatremia
less than 120 mmol/L
Value for Hypokalemia
less than 2.5 mmol/L
What happens when you frequently urinate when you are diabetic?
Electrolyte imbalance
What is the condition when the patient has glucosuria, polyuria, ketonuria, and metabolic acidosis constitutes what condition?
Diabetic ketoacidosis
which is common in Type I Diabetes Mellitus. It can also happen in Type II Diabetes Mellitus when the sugar is uncontrolled
What happens to the pH when the body releases too much sodium bicarbonate?
Lower (Acidic pH) (Acidosis)
Rationale: If there is a problem with the bicarbonate in the kidneys, it is Metabolic acidosis.
In Type II DM, H-H-N-S
● Hyperosmolar
● Hyperglycemic
● Non ketotic
● Syndrome
In Type I DM, D-K-A
● Diabetic KetoAcidosis
● Glucosuria
● Ketonuria
● Polyuria
(3) EXTRACELLULAR HYPERGLYCEMIA
- Hyperosmotic Plasma
- Dehydration of Cells
- Hyperglycemic coma
In Osmotic Diuresis, sodium is decreased. This process will promote
secondary hyperaldosteronism
What is the function of
Aldosterone?
○ Responsible for sodium reabsorption
○ Promotes potassium deficiency
○ Even when you reabsorb a minute amount of potassium, dehydration still occurs because
of frequent urination. Patient will have hypokalemia.
In patients with ______________,
○ It will promote electrolyte imbalance
Diabetic Ketoacidosis
■ ___________- (less than 2.5
mmol/L)
■ ___________- (less than
120mEq/L)
Hypokalemia; Hyponatremia
It will promote electrolyte imbalance, mainly
■ Hypokalemia
■ Hyponatremia
