CARBOHYDRATES LEC

Question 1

Carbohydrates contain a ___ and ___ functional groups

Answer 1

carbonyl and hydroxyl

Question 2

How does glucose enter tissues like skeletal muscle and adipose tissue?

Answer 2

With the help of insulin by stimulating the expression of glucose transporter 4

Question 3

Which organ is completeley dependent on glucose for energy production?

Answer 3

The brain

Question 4

2/3 of glucose utilization in resting adults occur in ___

Answer 4

CNS

Question 5

Carbohydrates may be classified according to:

Answer 5

Number of carbons
Location of carbonyl functional group
Number of sugar units

Question 6

Major storage form of glucose in man

Answer 6

glycogen

Question 7

Percentage of glycogen stored in the liver and skeletal muscle

Answer 7

85% and 15%, respectively

Question 8

microvascular complications of DM

Answer 8

nephropathy, neuropathy, retinopathy

Question 9

macrovascular complication of DM

Answer 9

atherosclerosis

Question 10

intermediate products of glucose metabolism

Answer 10

pyruvic acid. lactic acid, acetylcoA

Question 11

end products of glucose metabolism

Answer 11

CO2, H20, ATP

Question 12

Why does no CHO degradation happens in the stomach?

Answer 12

The salivary amylase is inactivated by gastric acid (ph 1-3 due to HCl content)

Question 13

____ of glucose on C6 into ____ by ___. This process traps the glucose inside the cell

Answer 13

Phosphorylation; glucose 6- phosphate ; hexokinase

Question 14

____ of glucose 6-phosphate into _____ by _____

Answer 14

Isomerization; fructose 6-phoshapte ; phosphoglucomutase

Question 15

_______ of fructose 6-phosphate on C1 forming _____ by ______

Answer 15

Phosphorylation;1-6 fructose biphosphate; phosphofructokinase

Question 16

____ of fructose 1,6-biphosphate into isomers ___ and ____ by ____

Answer 16

Split; DHAP and GAP; aldolase

Question 17

____ of DHAP into ____ by ____

Answer 17

Conversion; GAP; triose phosphate isomerase

Question 18

_____ and phosphorylation at C1 into _____ by ____

Answer 18

Dehydrogenation; 1-3 biphosphoglycerate; glyceraldehy 3-phosphate dehydrogenase

Question 19

___ of the high energy bond at C1 by _____ yielding ATP and the product ____

Answer 19

Hydrolysis; phosphoglycerate kinase; 3-phospholycerate

Question 20

___of phosphate from C3 to ____ forming ____ by _____

Answer 20

Shifting;C2; 2-phosphoglycerate; phosphoglycerate mutase

Question 21

___ of 2-phosphoglycerate by ___ forming

Answer 21

Dehydration; enolasel phosphoenolpyruvate

Question 22

____ of the high energy bond yielding ___ and ___ by the enzyme ____

Answer 22

Hydrolysis; pyruvate; ATP pyruvate kinase

Question 23

lycolysis (EMP Pathway is ____

Answer 23

anaerobic

Question 24

In the presence of oxygen, pyruvate is further oxidized to ____

Answer 24

CO2

Question 25

In the absence of O2, pyruvate can be fermented to

Answer 25

lactate or ethanol

Question 26

Responsible of the synthesis of reduced glutathione and NADPH to protect cells from oxidative stress

Answer 26

Pentose Phosphate Shunt/Hexose Monophosphate Pathway

Question 27

Maintains iron in the ferrous (Fe2+) state since ferric (Fe3+) are incapable of binding oxygen

Answer 27

Methemoglobin Reductase Pathway

Question 28

Responsible for the synthesis of 2,3- diphosphoglycerate to enhance oxygen delivery to tissues

Answer 28

uebering-Rapaport Pathway

Question 29

beta cells produce:

Answer 29

insulin, islet amyloid polypeptide or amylin

Question 30

alpha cells produce:

Answer 30

glucagon

Question 31

delta cells produce

Answer 31

somatostatin

Question 32

PP/F cells produce

Answer 32

pancreatic polypeptide

Question 33

ratio of C-peptide to insulin

Answer 33

5:1 or 15:1

Question 34

Duct cells: ____ and section is controlled by ____

Answer 34

bicarbonate ions; secretin

Question 35

Acinar cells: Digestive enzymes which include ___, ____, ___, and ___ whose secretion is controlled by ___

Answer 35

pancreatic amylase, lipase, trypsinogen and chymotrypsinogen; cholecystokinin

Question 36

Analogy: Post prandial state: ______ _____: Glycogenolysis Long fasting state: _____

Answer 36

Glycolysis Short fasting state Gluconeogenesis

Question 37

Only hypoglycemic hormone

Answer 37

Insulin

Question 38

Why is the ratio of C-peptide to insulin in the serum 5:1 to 15:1

Answer 38

increased hepatic clearance of insulin

Question 39

Actions of insulin

Answer 39

1. Promotes cellular entry of glucose into the insulin- sensitive tissues (liver, skeletal muscle and adipose) as energy source through glycolysis 2. Promotes glycogenesis 3. Promotes lipogenesis 4. Inhibits glycogenolysis

Question 40

The primary hyperglycemic hormone

Answer 40

glucagon

Question 41

major INHIBITORY hormone

Answer 41

somatostatin

Question 42

``` Each hormone is being secreted by: Cortisol: ____ epinephrine: _____ Somatotrophin:_____ Thyroxine:____ ```

Answer 42

Zona fasciculata of the adrenal cortex Chromaffin cells of the adrenal medulla Anterior pituitary gland Follicular cells of the thyroid gland

Question 43

HYPERGLYCEMIA: LAB FINDINGS

Answer 43

1. Increased plasma and urinary glucose 2. Increased urine specific gravity 3. Increased serum osmolality 4. Ketones in serum or urine 5. Decreased blood and urine pH (acidosis) 6. Hyponatremia: decreased plasma sodium (due to losses [polyuria] and shift of water from cells) 7. Hyperkalemia: increased plasma potassium (cellular shift secondary to acidosis) 8. ↓pCO2 due to Kussmaul Kien respiration (deep rapid respirations) 9. Decreased bicarbonate 10. Increased anion gap

Question 44

Ketosis develops in DM from excessive synthesis of _______ which can be reversed by insulin administration.

Answer 44

acetyl-CoA

Question 45

Nerve damage, known as _____occurs in 60% to 70% of people with diabetes

Answer 45

diabetic neuropathy

Question 46

Former names of Type 1 DM

Answer 46

Insulin-dependent diabetes mellitus, juvenile onset diabetes mellitus, Brittle diabetes, Ketosis-prone diabetes

Question 47

Autoantibodies responsible for beta cell destruction

Answer 47

Antibody to GAD65: highest sensitivity (91%), more common in adults Insulin autoantibodies (IAAs): more common in children Autoantibodies to insulinoma-associated protein 2 (IA-2) Autoantibodies to zinc transporter 8 (ZnT8)

Question 48

Former names of Type 2 DM

Answer 48

non-insulin dependent DM, adult- type/maturity-onset DM, stable diabetes, ketosis- resistant, receptor-deficient DM

Question 49

untreated type II DM will result to _______ due to overproduction of glucose accompanied by ___-,___,____

Answer 49

nonketotic hyperosmolar come; severe dehydration ; electrolyte imbalance; increased BUN and creatinine

Question 50

risk factor for Type 2 DM

Answer 50

Overweight (BMI ≥25 kg/m2), Sedentary lifestyle Family history of diabetes Advanced age (≥45 years) Ethnicity (African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders) Polycystic ovary disease History of gestational diabetes Delivery before diabetes of a baby weighing more than 9 pounds Hypertension, vascular disease or dyslipidemia (HDL cholesterol ≤35 mg/dL and/or triglyceride level ≥250 mg/ dL) HbA1c of 5.7% or greater Impaired fasting glucose or impaired glucose tolerance, Other conditions associated with insulin resistance (i.e., acanthosis nigricans)

Question 51

____ is high in diabetic ketoacidosis and ___ with treatment whereas ____ and ____ rise on treatment

Answer 51

Beta-hydroxybutyrate (ketone body) ; falls; acetoacetic acid and acetone

Question 52

T or F: Reagent strips for detection of ketones is used to monitor recovery for diabetic ketoacidosis since the strip is sensitive to presence of beta- hydroxybutyrate.

Answer 52

FALSE; not used to monitor recovery for DKA since the strip is not sensitive to Beta-hydroxybutyrate

Question 53

Which is used to monitor recovery from DKA?

Answer 53

anion gap

Question 54

OTHER SPECIFIC TYPES OF DIABETES

Answer 54

1. Pancreatic disorders/pancreatectomy 2. Endocrine disorders: Cushing's syndrome, pheochromocytoma, acromegaly, hyperthyroidism 3. Drug or chemical inducers: dilantin and pentamidine (anticonvulsants) 4. Genetic syndromes: Down syndrome, Klinefelter syndrome, Turner syndrome etc. 5. Exocrine disorders: cystic fibrosis, neoplasia, hemochromatosis.

Question 55

Screening for GDM should be performed between ___ weeks of gestation

Answer 55

24-28

Question 56

One Step Approach: ____ | Two Step: _____

Answer 56

IADPSG | NIH

Question 57

One Step Approach: | Uses a ____ oral glucose tolerance test, measuring glucose levels after fasting and at 1 and 2 hours

Answer 57

75 gram

Question 58

Criteria for OGTT

Answer 58

1. Ingest at least 150 g/day of carbohydrates for the 3 days preceding the test without limitation in physical activity 2. The test should be performed after an overnight 8- to 14-hour fast. 3. The individual should not eat food; drink tea, coffee, or alcohol; or smoke cigarettes during the test, and he or she should be seated

Question 59

Major cause of hypoglycemia

Answer 59

use of insulin or insulin secretagogue drugs (sulfonylureas)

Question 60

T or F: Severe hypoglycemia if not corrected in a timely fashion can be fatal

Answer 60

T

Question 61

Whipple's triad

Answer 61

Symptoms consistent with hypoglycemia Low plasma glucose Alleviation of symptoms upon glucose administration

Question 62

Classification of hypolgycemia (8)

Answer 62

1. Drug induced 2. Severe medical illness 3. hormonal deficiencies 4. endogenous hyperinsulinism 5. autoimmune hypoglycemia 6. non-islet cell tumor hypoglycemia 7. hypoglycemia of infancy and childhood 8. alimentary hypoglycemia

Question 63

____ and ____ are most commonly affected by defects in glycogen metabolism, as these tissues have abundant quantities of glycogen.

Answer 63

Liver, skeletal muscle

Question 64

liver glycogenosis usually manifests as ___ and ____

Answer 64

hypoglycemia; hepatomegaly

Question 65

muscle glycogenosis usually manifests as ___, ___, ___, ____

Answer 65

muscle cramps; exercise intolerance; fatigue; weakness

Question 66

Common name and enzyme deficient for Ia(L) and Ib(L)

Answer 66

Von Gierke; glucose 6-phosphatase; glucose 6-phosphatase translocase

Question 67

II(M): ____: acid maltase

Answer 67

Pompe

Question 68

Congenital deficiency of one of the three enzymes involved in the conversion of galactose into glucose.

Answer 68

Galactose-1-phosphate uridyl transferase Galactokinase Uridine diphosphate galactose 4-epimerase

Question 69

An autosomal recessive disorder characterized by accumulation of fructose in blood and urine due to lack of fructokinase

Answer 69

Essential fructosuria

Question 70

What enzyme is deficient in hereditary fructose intolerance which leads to inadvertent accumulation of fructose 1-phosphate

Answer 70

aldolase

Question 71

In fructose 1-6 biphosphatase deficiency, there is an impaired hepatic synthesis of gluconeogenic precursors ___, ___, and alanine leading to hypoglycemia

Answer 71

lactate, glycerol, alanine