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Published by: faats on Oct 07, 2010
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source of energy for the human body
aldehydes or ketones w/ 2 or more hydroxyl groups
classified: monosaccharides, oligosaccharides, and polysaccharides
Principal and most exclusive CHO circulating in the blood
Blood glucose---derived from the hydrolysis of dietary starch, from
conversion of other dietary hexose into glucose by the liver, and
from the synthesis of glucose from AA, FA and lactate
Principal fuel for peripheral tissues
Maintained by metabolic processes and hormonal control
*small peptide secreted by the beta
cells of the pancreatic islets of
Langerhans in respons to an blood
glucose level
The only hormone that lowers the
blood glucose
Increasing membrane permeability
to glucose by binding to receptors
on cell surface- entry into liver,
muscle and adipose tissue
Enhancing the synthesis of
glycogen, lipid and CHON
Blood glucose, insulin is
Blood glucose, inhibits release
of insulin
Polypeptide hormone secreted by
the α cells of the pancreatic islets of
Langerhans in response to a low
blood glucose level
Principal hormone for producing a
rapid increase in the concentration
of glucose in the blood
Stimulates hepatic glycogenolysis
and gluconeogenesis
Increases glucose by:
stimulating glycogenolysis and
lipolysis while inhibiting the
release of pancreatic insulin
Secreted by thyroid gland
Promotes glycogenolysis and
can lead to a depletion of
glycogen stores in the liver
Growth Hormone
Adrenocorticotropin ACTH
Somatotropin, secreted by
the anterior pituitary
Inhibits glucose uptake by the
Stimulate liver
glycogenolysis- raising
glucose concentration
Stimulates the release of
cortisol from the adrenal gland-
increasing glucose level
Stimulates gluconeogenesis
***Somatostatin, Somatomedins
Disorders of Carbohydrates:
increased plasma glucose concentration (hyperglycemia)
decreased plasma glucose concentration (hypoglycemia)
normal or decreased plasma glucose, often with the excretion of a nonglucose reducing sugar in the urine (inborn errors of carbohydrate
Hyperglycemia: Diabetes Mellitus
most important disease associated with hyperglycemia
characterized by: deficiency of insulin secretion or action resulting in hyperglycemia and the probable development of complications overtime
Type I DM
Laboratory Findings
severe form of DM
characterized by absolute deficiency of insulin (autoimmune destruction or
degeneration of the pancreatic islet beta cells)
ciral or chemical, genetic
islet cell autoantibodies, insulin autoantibodies etc…
abrupt onset of symptoms, often following viral infection and proneness to
require insulin treatment to prevent ketosis and sustain life
history of rapid weight loss, polyphagia, polydipsia, polyuria
neurologic: confusion, disorientation and loss of consciousness
Hyperglycemia ( blood glucose level)
Polyuria,urine and serum osmolality, specific gravity,
ketonemia, ketonuria, acidosis, electrolyte imbalance
*occur at any age, frequently juveniles
10% of all cases of DM
Asian or African descent
Type II DM
Gestational DM
Milder form of DM
Characterized by a relative deficiency of insulin activity due to insulin
resistance (insulin level normal, but insufficient peripheral response to the
insulin), and insulin secretory defect
amyloid deposition (starchlike-protein-carbohydrates complex) in tissues
Environmental factors: intake of excessive calories, lack of physical exercise
No relationship to viruses
Not prone to ketosis; usually do not require insulin
risk of developing vascular complication and hyperosmolar coma
Obese, after age 40 and progress slowly
Most common form of DM, accounts for 80 to 90% of patients
During pregnancy due to hormonal and metabolic changes
Family history of diabetes; history of recurrent monilial infections or
reproductive history of large babies (>4000g) or infants w/
congenital anomalies
Maternal symptoms mild; on fetus can be devastating (congenital
malformation and perinatal mortality)
After delivery- revert to normal or develop DM later in life
IGT (impaired glucose tolerance)
IFG(impaired fasting glucose)
Plasma glucose levels following an oral glucose load that are not normal yet
not sufficiently abnormal to be classified as DM
Plasma glucose levels following an 8-hour fast that are greater than
normal but not sufficiently elevated to be classified as DM
Type I
Type 2
Low levels of insulin-entry of glucose into cells is impaired-
resulting in elevated blood glucose
Elevated glucose exceed the renal reabsorptive capacity, glucose is
excreted in the urine-glycosuria or glucosuria
Since water is excreted w/ the glucose-thirst and hungry-
polydipsia (intake of large volume of water) and polyphagia
(excessive desire for eating)
Increased level of glucagons
Glycolysis is inhibited---glycogenolysis, lipolysis and gluconeogenesis
are stimulated
Catabolism of AA and FA-amounts of acetyl CoA-converted to
holesterol or ketoacid, acetoacetic acid, beta-hydroxybutyric acid
and acetone---KETOSIS
Ketonemia (ketones in blood)
Ketonuria (ketones in urine)
Sweet “organic” odor (acetone)
Overproduction of ketoacids-acidosis or lowered blood pH-
decreasing bicarbonate concentration-to yield CO2 and H2O
Depletion of bicarbonate-metabolic acidosis
Respiratory center stimulated- rapid, deep breathing and
increased excretion of CO2 by the lungs---coma may result
Hyperglycemis hyperosmolar nonketotic coma
*leading to urinary losses of H2O, glucose and electrolytes (osmotic diuresis)
without sufficient fluid replacement- dehydration- extremely high blood
glucose and finally coma
Elderly patients
Dietary measures
Insulin or oral hypoglycemic agents
*complication w/in 10 to 15 years
Kidney failure (nephropathy)
Microvascular/macrovascular disease
Heart attacks and strokes due to vascular complications
Arterisclerosis---diminish blood flow to the legs---gangrene
Susceptibility to infection
3 criteria:
oSymptoms of DM + random plasma glucose >200mg?dL (11.1mmol/L)
oFasting plasma glucose : 126mg/L ( 7.0 mmol/L)
oOGTT: 2 hours after oral glucose load >200mg/L (11.1mmol/L)
Casual (Random) plasma
Fasting Plasma Glucose
Urine Glucose
Two-hour postprandial plasma glucose
Collected irrespective of when
the last meal was ingested or
time of the day
>200mg/L (11.1 mmol/L)—
presumptive of DM
8 hours or more fasting
w/o any caloric intake
Glucose in urine 160
to 180 mg/L (8,9to
10 mmol/L)
Screening test
2 hours after patient consumes standard load of glucose
>200mg/L (11.1mmol/L)---DM
Oral Glucose Tolerance Test (OGTT)
Glycated Hemoglobin
Unlimited physical activity and unrestricted diet 150g CHO for 3 days
Test perform in the morning after fasting 10 to 16 hours (only water
is permitted)
Fasting glucose collected
Glucose for nonpregnant 75g in flavored solution (1.75 g/kg body
weight---pedia; 100g for pregnant women
Drink ingested 5 minutes
Plasma glucose measured every 30 minutes for 2 hours
Patient seated throughout the test
Samples collected in sodium fluoride; within 4 hours
normal: rise about 150mg/L (8.3mmol/L) or higher w/in 30 to 60
minutes---normal in 3 hours
diabetic: higher for longer period of time
gestational diabetic (2): fasting >105mg/L (5.8); 1-hour glucose
>190mg/L (10.6); 2-hour >165mg/L (9.2); 3-hour >145mg/L (8.1)
factors affect OGTT: illness, trauma, stress, some drugs
Glycosylated hemoglobin; Hb A1c
Useful in determining compliance with therapy; extent to which satisfactory
diabetic control has been achieved
More convenient than OGTT
Requires only 1 blood sample
Self-monitoring of blood glucose
Use capillary whole blood
Serum/plasma glucose values higher than the capillary whole blood level
Syndrome characterized by low glucose <50mg?L (2.8mmol/L)
Reactive hypoglycemia---excessive administration of insulin
Factitious hypoglycemia—other hypoglycemic agent
Ethanol ingestion—reduction of gluconeogenesis
Fasting or spontaneous hypoglycemia---uncommon
~rapid fall in plasma glucose: triggers the release of epinephrine and symptoms caused by epinephrine
Weakness, sweating, shakiness, trembling, nausea, lightheadedness, rapid pulse
Adrenergic symptoms
~gradual fall in plasma glucose: <20 or 30 mg?L (1.1 or 1.7 mmol/L)
Causes impairment of CNS function
Neuroglycopenia: headache, confusion, lethargy, unconsciouness
Samples drawn frequently every 4 hours

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