CARBOHYDRA

TES
Maria Joanne Dente,
RMT
CARBOHYDRATES
- Primary source of energy
- Organic compound made up of
Carbon, Hydrogen and Oxygen
- absorbed in the simplest form, as
monosaccharides (glucose)
MONOSACCHARIDES
(CH2O)n
A. Number of Carbon Atoms
Number of
Carbon
Example
Triose 3 Glyceraldehyde
Tetrose 4 Threose, Erythrose
Pentose 5 Ribose, Xylose, Xylulose
Glucose, Galactose,
Hexose 6
Fructose, Mannose
 MONOSACCHARIDES
(CH2O)n

B. Aldoses
and Ketoses

Aldose = aldehyde
Ketose = ketone
MONOSACCHARIDES
(CH2O)n
C. D or L configuration
POLYSACCHARIDES
Disaccharides
Sucrose
Lactose
maltose
Oligosaccharides
2 10 monosaccharide
Polysaccharides
>10 monosaccharide connected by
glycosidic bonds
ARBOHYDRAT
E DIGESTION
1 2 3
CARBOHYDRATE DIGESTION
CARBOHYDRAT
E ABSORPTION
1 2 3
CARBOHYDRATE ABSORPTION
CARBOHYDRATE ABSORPTION
 CARBOHYDRA
E METABOLISM
1 2 3
IMPORTANT
PATHWAYS
Glycolysis
Tricarboxylic Acid Cycle
Electron Transport Chain
Rapoport Luebering Pathway
Hexose Monophosphate
Shunt
GLYCOLYSIS
- Embden-Meyerhoff Pathway
- Generates ATP (minimal)
- Pyruvate/lactate as end
product
- Occurs in the cytosol
- Important pathway for
erythrocytes
GLYCOLYSIS
Overall Reaction:
Glucose + 2Pi + ADP + 2
NAD+ 2 Pyruvate + 2ATP +
2 NADH + 2 H+ + 2H2O
Fate of Pyruvate
ATP PRODUCTION
IMPORTANT
PATHWAYS
Glycolysis
Tricarboxylic Acid Cycle
Electron Transport Chain
Rapoport Luebering Pathway
Hexose Monophosphate
Shunt
KREBS CYCLE
Tricarboxylic Acid Cycle/ Citric Acid Cycle
Final common pathway for carbohydrate
metabolism
Generates much more ATP than glycolysis
Occurs in the mitochondria
Generates the metabolic intermediates for
the electron transport chain
Only in aerobic state
IMPORTANT
PATHWAYS
Glycolysis
Tricarboxylic Acid Cycle
Electron Transport Chain
Rapoport Luebering Pathway
Hexose Monophosphate
Shunt
RESPIRATORY CHAIN
Electron Transport Chain
Occurs in the mitochondria
Process in which reducing equivalents
from the CAC and Glycolysis are
converted into high energy ATP via
oxidative phosphorylation
Oxidative Phosphorylation
IMPORTANT
PATHWAYS
Glycolysis
Tricarboxylic Acid Cycle
Electron Transport Chain
Rapoport Luebering Pathway
Hexose Monophosphate
Shunt
RAPOPORT LUEBERING
Pathway present in RBCs
Form 2,3-Bisphosphoglycerate/ 2,3
Diphosphoglycerate decreases the
affinity of oxygen to haemoglobin for
more efficient oxygen unloading and
delivery to tissues
GLYCOLYSIS IN RBCs
IMPORTANT
PATHWAYS
Glycolysis
Tricarboxylic Acid Cycle
Electron Transport Chain
Rapoport Luebering Pathway
Hexose Monophosphate
Shunt
HEXOSE MONOPHOSPHATE
Pentose Phosphate Pathway
Phosphogluconate Pathway
RBCs (also in testis, adipose, lactating
mammary gland, adrenal cortex, liver)
Two functions:
1. NADPH production
2. Ribose production
TERMINOLOGY
1. Glycolysis
2. Gluconeogenesis
3. Glycogenolysis
4. Glycogenesis
5. Lipolysis
6. Lipogenesis
REGULATION
1. Consider state of the individual.
Fasting or Fed State?
At rest? Exercise?

2. Endocrine regulation
REGULATION
2. Endocrine regulation
a. Insulin
b. Glucagon
c. Somatostatin
d. Epinephrine
e. Cortisol
f. ACTH
g. Thyroxine
h. Growth Hormone/ Somatotropin
 SPECIMEN
1. Urine
2. CSF
3. Pleural fluid
4. Serum
5. Plasma (Na Fluoride) standard
clinical specimen
6. Whole blood
 SPECIAL
CONSIDERATIONS
UNPROCESSED SPECIMEN
A. At room temperature (22 - 27c)
- Loss of 7 mg/dL of glucose / hour
B. At ref temp (4c)
- Loss of 2 mg/dL glucose / hour

BACTERIAL INFECTION = false

decreased level
TESTS FOR GLUCOSE
Glucose Oxidase Method
D-glucose + H2O + O2 gluconic acid + H2O2
H2O2 + chromogen chromogen (oxid) + H2O

Hexokinase
Glucose + ATP G6P + ADP
G6P + NADP+ 6-phosphogluconate + NADPH
+ H+
TESTS FOR GLUCOSE
Copper Reduction Methods
Nelson - Reduces copper in hot alkaline
Somogyi solution to cuprous ion which in turn
reduces arsenomolybdic acid in a
greenish-blue complex
Folin Wu Reduction of copper in hot alkaline
solution to cuprous ion causing the
reduction of phosphomolybdic acid
forming a blue complex of
molybdenum oxide

Neocuproine Neocuproine (2,9 dimethyl 1,10

method phenanthroline hydrochloride)
complexes with cuprous ion to form a
yellow color
HYPOGLYCEMIA
Strict glucose-requiring organs:
Brain and RBCs
Decrease in glucose levels below 50
mg/dl
HYPERGLYCEMIA
DIABETES MELLITUS
Increased blood glucose levels due to
either deficient insulin levels or
insulin resistance
3Ps: Polyphagia, Polydipsia, Polyuria
DIABETES MELLITUS
DIABETES MELLITUS
Classification of DM
DIABETES MELLITUS
A. FBS/FBG
6 8 hours fasting
10 12 hours (with lipid profile)
Normal 70 110 mg/dl
Impaired glucose 110 126 mg/dl
tolerance/ pre-diabetes

Diabetes >126mg/dl
DIABETES MELLITUS
TESTS FOR DIAGNOSIS
B. 2 hour Postprandial Blood
Sugar
- Insulin activity
NV: <140 mg/dl

C. Random Blood Sugar

NV > 200 mg/dl
DIABETES MELLITUS
D. Oral Glucose Tolerance Test
75 g glucose load (within 10 minutes)
Patient preparation: 150 grams high carb
diet or 3 days; fast for 8 14 hours

Normal individuals: a rise in blood

glucose after drinking and a reversal to
normal levels after 2 hours
DIABETES MELLITUS
E. Oral Glucose Challenge Test
- 50g glucose load
- For pregnant mothers
- To detect gestational diabetes
DIABETES MELLITUS
F. HbA1c
- Glycosylated hemoglobin/
Glycated hemoglobin
- Monitoring of glucose up to 2 3
months
Specimen: whole blood (EDTA)
- Diabetes >6.5
DIABETES MELLITUS
G. Fructosamine
- 3 6 weeks
- For patients with
hemoglobinopathies
Specimen: serum