Unit 3 carbohydrates Flashcards

Carbon + Water = Carbohydrate

Right in Latin

Left in Latin

Glucose and Glucose

Note: GG I’m getting a Malt shake

Glucose and Galactose

Lactose like the world eater Galactose

Glucose and Fructose

Sucrose is Fruit sugar

One double bonded Oxygen to a Carbon

aldose or aldehyde

ketose or ketone

Ketone: are in the middle.

all monosaccharides

is the random binding and releasing of the aldehyde and hydroxyl groups in the carbohydrate ring, which enables a transient reduction capacity of other substances. The end sugar on chain to become a reducing sugar

the storage form of glucose for our bodies

1. Start with glucose
2. End with pyruvate
3. Produces 2 ATP and 2 NADH

Breakdown of glucose to pyruvate (with oxygen, aerobic glycolysis) or lactate (without oxygen, anaerobic glycolysis)

Turns acetyl Co-A into ATP for energy, and gives off electrons and H+

Oxidation of glucose to ribose + CO 2 + NADPH. Ribose for RNA and DNA

- Formation of glycogen for energy storage

- Destruction of glycogen for energy usage

Formation of glucose from non-carbohydrate sources

- Destruction of glucose into pyruvate or lactate

- ↑ glycolysis, glycogenesis, and lipogenesis. Released from the pancreatic

↑ glycogenolysis, gluconeogenesis, lipolysis

Released from the pancreatic

Inhibits secretion of glucagon and insulin

Released from the Pancreatic ẟ cells, islets of Langerhans Note: statin for stable.

↑ glycogenolysis, gluconeogenesis

(Thyroxine, Growth Hormone, ACTH, Glucocorticoids, Epinephrine)

Insulin

1. Polyuria: pee a lot
2. Polydipsia drink: a lot,
3. Polyphagia eat: a lot

Fasting Blood Sugar >126 mg/dL

Random Blood Sugar >200 mg/dL

2 hour Oral Glucose Tolerance Test "OGTT " >200 mg/dL

HbA1c >6.5%

Renal damage - assess microalbumin (more sensitive in assessing glomerular function than Creatinine)

Cardiac damage - assess EKG (best screening test for stress on the heart)

Retinal damage - yearly ophthalmologist exam (best screening for diabetic retinopathy)

Diabetic foot ulcers - weekly/daily self check and prevention by avoiding injuries

Fasting blood sugar >92 mg/dL

1 hour Oral Glucose Tolerance Test (OGTT) >180 mg/dL

2 hour OGTT >153 mg/dL

Elevated blood sugar increases the rate of Intrauterine Fetal Demise (IUFD)

Don’t want to birth a dead baby.

< 60 mg/dL in adults

< 45 mg/dL in infants,

1.Documentation of hypoglycemia when symptomatic

2.Signs and Symptoms of hypoglycemia

3.Alleviation of symptoms after ingestion of glucose

1.Sweating

2.Shaking

3.Nervousness

4.“Feeling of impending doom”

Hypersecretion of insulin following the ingestion of food

!Reference Range for Glucose = 70-100 mg/dL!

Critical Serum or Plasma Glucose (All ages)

Below 40 mg/dL Brain Damage

Above 450 mg/dL Diabetic Coma

Critical Plasma Glucose (Newborn to 6 Wks)

Below 30 mg/dL Brain Damage

Above 300 mg/dL Diabetic Coma

Cause of ‘failure to thrive’ in infants

May lead to irreversible mental retardation, cataracts, and eventually blindness

Lab findings: 1. hypoglycemia 2. hyperbilirubinemia 3. accumulation of glycogen

caused by inability to turn glycogen into glucose

Most common enzyme deficiency worldwide. Most people are asymptomatic.

Enzyme deficiency for the last step in glycogenolysis, Glycogenolysis cannot occur

Episodes of intravascular hemolysis can occur after Plasmodium vivax infection, ingestion of medications that induce oxidative stress (Rifampin, methylene blue, Primaquin, Rasburicase, Sulfa drugs, etc.), fava beans, infections, or ketoacidosis

Glucose + O2 + H2O → Gluconic acid + 2 H2O2

H2O2 oxidizes many substrates catalyzed by Horseradish Peroxidase

H2O2 + reduced chromogen → Oxidized chromogen + H2O

Catalyzes G-6-P formation in the presence of Mg ++

H2O2, Hydrogen Peroxide

Normal range is between 4.8-5.9%

Diabetes is diagnosed with a HbA1c >6.5%

note:Glucose binds non-enzymatically to all proteins

HbA1c works just fine, until it doesn’t.

This can be caused by early red cell destruction like hemolysis, or more commonly dialysis.

HbA1c initially, because it looks at the glycosylated hemoglobin molecules still in the blood. Since red cells turn over every 90 days or so, this test is only good to look at the last 90 days of control. If the patient has high red-cell turnover (sickle cell anemia, hemolysis, bleeding, etc.), then the test will not look at the last 90 days, and a fructosamine or glycated albumin test should be ordered.

Lactate is produced in glycolysis when oxygen is NOT present (e.g. exercise, heart attack, etc.)

Interferences:

• Bilirubin over 274 umol/L
• Hemolysis over 5.0 g/L
• Lipemia over 11.3 mmol/L
• Ascorbate over 568 umol/L

Know that the chromogen creates a color change

the presence of glucose in the CSF and is a NORMAL finding

!CSF glucose should be ⅔ the plasma glucose!

!The Renal Threshold for glucose is 180 mg/dL!

Acetoacetic acid

Hyperinsulinemia, either an insulin-secreting tumor or exogenous insulin administration

Insulin insensitivity

Type I Diabetes

Starvation, ↑ Glucagon

C-Peptide and Insulin are created in a 1:1 ratio
If a patient lakes C-peptide, but has lots of insulin in comes from an injection. Could mean murder or Munchausen syndrome a mental condition in which a person repeatedly seeks medical attention for falsified, exaggerated, or self-inflicted physical symptoms.

These are just example know the principle not the exact numbers.

1. Plasma 100 mg/dl
2. Red cells 70 mg/dl
3. whole blood 88 mg/dl Note: this is the average of plasma and red cells

Answer: Anaerobic glycolysis is likely being used in this situation. Anaerobic
glycolysis is the body’s last ditch effort to try and create some ATP. It is not
efficient at all and only creates 2 ATP, whereas, with the use of the electron
transport chain and the presence of oxygen as the terminal electron acceptor,
38 ATP can be created from each molecule of glucose. That’s a much better
investment!

Acetoacetic acid

Insulin

Action:↑ gluconeogenesis ↑ glycogenolysis

Source:Thyroid gland

Action: Inhibits secretion of insulin and glucagon

Source: ẟ cells in the pancreas

Action: ↑ gluconeogenesis ↑ glycogenolysis ↑ lipolysis

Source: Anterior pituitary gland

Action: ↑ gluconeogenesis ↑ glycogenolysis ↑ lipolysis

Source: Anterior pituitary gland

Action: ↑ gluconeogenesis ↑ glycogenolysis ↑ lipolysis

Source: Adrenal medulla

Action: ↑ gluconeogenesis ↑ glycogenolysis ↑ lipolysis

Source: Adrenal cortex

Hexokinase

Na fluoride (gray top)

Answer:
The correct answer is D) The sample is not the same. This question has a couple of
steps to it, so let’s start at the surface then go to the underlying problem. The patient is complaining of nonspecific symptoms, so we can’t tell what’s going on clinically. We also know that he is comparing laboratory results, which are spun down, so the sample is usually plasma. The sample for at home blood monitoring is whole blood. Most people don’t have a centrifuge for at home use.

(Answer A) The laboratory is in a better controlled environment is a true statement, but doesn’t likely apply in this case. We also know that he is being treated with IVIG, which contains maltose. Maltose cross-reacts in the glucose oxidase method and falsely-elevates the glucose value (Answer C). Maltose does NOT do this with the hexokinase method. This would be a problem (Answer B) IF we were comparing these two test methods.

Answer:
The correct answer is B). Cushing syndrome is defined by an increase in Cortisol which increases glucose levels in the blood. This makes it incredibly difficult to control blood sugar. ACTH is not correct because it refers to Cushing disease, which is specifically defined as an ACTH-secreting pituitary tumor. Cushing syndrome is the umbrella term for increased cortisol, but it doesn’t tell us exactly the mechanism behind it.

Answer:
The correct answer is C)

Answer:
HbA1c because it looks at the glycosylated hemoglobin molecules still in the blood. Since red cells turn over every 90 days or so, this test is only good to look at the last 90 days of control.

Hypersecretion of insulin following the ingestion of food

Myocardial Infarction, stroke, or renal failure

Answer:
200 mg/dL

Answer:
The correct answer is C) Myocardial infarction. This is one of the most dangerous long-term side effects of diabetes along with strokes and renal failure. We diagnose thisby evaluating troponin I (TnI). This becomes elevated to detectable levels in just 2-3 hours, whereas, the other specific marker for myocardial damage, CK-MB, does not elevate for 6-10 hours. This is why TnI is the best test. However, laboratories continue to offer CK-MB. There has been a push to replace CK-MB with Troponins.

Answer:
The correct answer is B) Postprandial Hypoglycemia. Recognize Whipple’s triad in this case presentation and these symptoms appear after meals. The only thing that we’re missing is documented hypoglycemia while the patient is symptomatic

The correct answer is A) 2 Hour OGTT. The 2 hour OGTT is a test in which a standard glucose load is given to the patient. We are interested in seeing how the patient decreases this glucose over the next 2 hours. This is demonstrated in the figure below: