PART 1 Flashcards by Toni Mae Inductivo

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.

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Simplest CHO:

Glyceraldehyde

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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

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All sugars must be digested to this monosaccharide.

Carbohydrates

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Serves as major source of energy for the body

Carbohydrates

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Sugar that contains 3, 4, 5, 6 carbon atoms (triose, tetroses, pentoses and hexoses, etc.)

Monosaccharide

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Glucose is the only monosaccharide used by the body for energy

Carbohydrates

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Sugar that cannot be hydrolyzed to a simpler form

Monosaccharide

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end product of CHO digestion is:

Glucose

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energy mediator of oxidation of glucose is:

ATP (Adenosine Triphosphate)

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glucose + glucose:

Maltose; Maltase

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Formed by interaction of two monosaccharides; separated by hydrolysis

Disaccharides

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glucose + galactose

Lactose; Lactase

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glucose + fructose:

Sucrose; Sucrase

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What organs produce maltose, lactose, and sucrose

Pancreas

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Remedy for constipation

Soluble fibers

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<10 - >2 monosaccharides (Soluble fibers)

Oligosaccharides

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Linkage of many monosaccharide units ; linked by glycosidic bond

polysaccharides

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Include starch (known polysaccharide), glycogen & cellulose

Polysaccharides

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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.

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Final hydrolysis

Small Intestine

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Metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both

DIABETES MELLITUS

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In severe DM the ratio of B-hydroxybutyrate to acetoacetate is ___

6.1

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Pathogenesis

β-cell destruction

TYPE 1 (IDDM

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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)

1. Adult Type 2. Maturity Onset 3. Stable Diabetes 4. Ketosis resistant 5. 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

1. Glucose <45mg/dL 2. Symptoms of Hypoglycemia 3. 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

1. Glucose Oxidase 2. 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

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

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:

1. Embden-Meyerhof (glucose→pyruvate) 2. Hexose monophosphate 3. 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

1. Hyperosmotic Plasma 2. Dehydration of Cells 3. Hyperglycemic coma

In Osmotic Diuresis, sodium is decreased. This process will promote

secondary hyperaldosteronism

What is the function of Aldosterone?

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

PART 1 Flashcards

(180 cards)