Alterations Chapter 1: The Metabolsm of Carbohydrates and its Alterations193

Carbohydrates
and its
Metabolism of
1 8 Chapter
1: The with glucose uptake into the liver a Glucocorticoids
effect. Glucose is continuously filtered by
(hypoglycemic
hormone)
carbohydrate meal. after a hormone
andl adrenocorticotropic the glomeruli but is normally reabsorbed
1. Insulin hormone)
o In the muscle and the n
Growth
completely in renal tubules. The capacity
2. Glucagon
(hyperglycemic
liver, insulin hormone (ACTH)

of the tubular system to reabsorb glucose is

stimulates glycogenesis by
Maintenance of Blood
Glucose
glycogen synthase and thereby stimulating a Thyroxine

the actions limited.

suppression of glycogenolysis. leading to

Glucagon opposes o Ifthe blood glucose level is raised above
by u cells of
(Hyperglycemic Clucagon:
in Fed State Glucagon is
of insulin.
secreled
180 mg/ 100 mL, complete tubular
Condition) n Insulin inhibits gluconeogenesis by response to low blood sugar
increased blood glucose suppressingthe action of key
he bancreas in causes an reabsorption of giucose does not occur
Normally, there is an
Glucagon
postprandial enzymes of Lovol in the lasting state, in and the extra arnount appears in the urine
meal, a gluconeogenesis, for example: concentration
levelshortly after each circulating increase in blood
glucose
the liver as causing glycosuria.
Increased level of " Pyruvate carboxylase Itacts primarily in
hyperglycemia.
the islets several ways.
insulin by ß cells of " PEP carboxykinase o 180 mg/100 mL is the limniting level of
glucose releases decreases follows:

This hormone stimulates glycogen break glucose in the blood, above which tubular
of the Langerhans. . Fructose-1,6-bisphosphatase n ln the liver, it
in a number of ways glycogen synthesis. reabsorption does not occur, which is
the blood glucose level " Glucose-6-phosphatase down and inhibits
(Figure 1.16): glucose is conye forned by the breakdown of also known as renal threshold value for
In adipOSe tissue, Theglucose
Bv stimulating the active
transport ol
released from the liver into glucose.
membranes of muscle
the glycerol-3-phosphate, needed for the glycogen is then
glucose across cell
formation of triacylglycerol (lipogenesis) blood. The liver glycogen is capable
of o Thus, by excretíng extra armount of sugar in
not the liver. the
and adipose tissue but and inhibits the lipolysis by inhibiting Imaintaining the blood glucose
concentra the urine during hyperglycemic state and
Glucose is rapidly taken up
into liver as it 8-12 hours. reabsorbing sugar during the hypoglycernic
to glucose via GLUT-2
hormone-sensitive lipase. tion at nornal values for
istreely permeable
n Insulin increases protein synthesis and gluconeogenesis from state, the kidney helps in regulating the
n Glucagon enhances levelof glucose in blood.
transporter.
the use of decreases protein catabolism, thereby amino acids and lactate by inducing the
D In the liver, insulin increases gluconeogenesis.
decreases the release of amino acids. action of key enzymes of
glucose by glycolysis by inducing the GLYCOSURIA
Synthesis of key glycolyic enzynes:
All these mechanisms are responsible for a Lactate formed by oxidation of glucose in
" Glucokinase drop in glucose level and create hypoglycemia. skeletal muscle is transported to the iver Normally, the urine contains about 0.05 g5
" Phosphofructokinase by lactic acid (Cori) cycle (Figure 1.10). of sugar. Such a small quantity cannot be
Maintenance of Blood Glucose secreted detected by Benedict's test, but under certain
" Pyruvate kinase n Epinephrineor adrenaline: It is
in Fasting State (Hypoglycemic
5Glucokinase is important in regulating Condition) by adrenal medulla. It
stimulates círcumstances, a considerable amount
blood glucose after mneal. Like hexokinase glycogenolysis in the liver and the muscle. of glucose may be excreted in the urine.
(of extrathepatic tissue). glucokinase w'ithin about Ihour after a meal, blood In the liver, glucose is the main product, Excretion of detectable amount of sugar in
of the liver is not inhibited by glucose glucose levels begin to fall and by 2 hours leading to increase in blood glucose. urine is known as gBycosuria.
6-phosphate. Glucokinase increases the level returns to the fasting range (70-100 Glucocorticoids: These hormones are Glycosuria results due to rise in blood
in activity whenever blood glucose mg/dL) and leads to hypoglycemia. For the secreted by adrenal cortex, which stimulates glucose above its renal threshold level (180
concentration is higher than normal levels brain, the ervthrocytes, the bone marrow, gluconeogenesis by increasing the activity of mng%). Glycosuria may be due to various
and seems to be specifically concerned the renal medulla, and peripheral nerves, enzymes of gluconeogenesis. reasons on the basis of which it is classified
glucose is the major fuel, which has to be Anterior pituitary hormones: Growth hor into the following groups:
Acsve transport of ghase in
muscde and adipose cele supplied for theirenergy needs. Therefore, mone antagonizes the action of insulin by 1. Alimentary glycosuria
Gycolysis it is essential to maintain the blood glucose decreasing the glucose uptake in the muscle 2. Renal glveosuria
O'ycugess
level within normal range. The blood glucose and ACTH decreases glucose utilization by 3. Diabetic glycosuria
Hypopycic level is naintained within normal range by the tissue.
Lpogera Proin
Sttesis the following ways. Thyroxine: Thyroxine accelerates hepatic
Alimentary Glycosuria
(Lipolyss The decrease in blood glucose (hypogly glycogenolysis with consequent rise in blood The blood sugar level of some individuais
Glycngenolyss cernia)causes decrease in insulin secretion glucose. after meal rises rapidly above the normal renal
Gluconepenesis Prcleks threshold ( 180 mg.) and results in glycosuria
and stimulates the release of hyperglycemic
catabolsm
hormones, for example: RenalControl Mechanism and known as ulimentary glycosuriu. This
Fiqure 1.16: Various metabolic systerns oGlucagon When blo0d glucose rises to relativeBy high is due to an increased rate of absorption
affected by insulin levels, the kidney also exets a legulatory of glucUse from the intestine This is called
D Epinephrine or adrenaline
 Alterations Chapter 1: The Metabolism of Carbohydrates and its Aiterations
Carbohydrates and its
Metabolism of
1: The diabetes include increased Treatment
2 0 Chapter hunger,
thirst, weight loss, ,írequent urination,incrcased
alimentary canal
since Treatment
glycosuria
, sofiDDM (type-1)
fail to secrete Noninsulin-dependent diabetes mellitus
vision changes, tingling or numbnesssudden
alimentary

exogenous insulin (type-2) can be treated in early stages by

patients
is ivolved.
of this
glycosuria
feet, , and in the Since administration of
characteristic feature hands or feeling very tired diet control, exercise, and weight reduction.
The
high blood glucose
levelreturns
he time. much of
insulin,

and no exogenous insulin administration is

isthat usually This type of
is r e q u i r e d .

meal.
hours after a
to nonalin 2 required. However, in the later stages, insulin
Type-2Diabetes Mellitus

glycosuria is benign
(harmless). Classification of Diabetes Mellitue NIDDM or adult-onset administration is often required to control
alsoocalled
Diabetes mellitus is broadly divided is
Renal Glycosuria groups, namelv:
linto two Type-2
diabetes mellitus.
blood glucose.
impaired tubular The comparison between two types of
due to
This is observed 1. Type-1 diabetes mellitus or diabetes mellitus is given in Table 1.3.
reabsorption of glucose
and have lowered insulin:
dependent diabetes mellitus (IDDM)
Cause
sensitivity(decreased
130-150 mg%) for caused by decreased
(maybe Iris
to insulin) of ftissuestoinsulin, This Complications of Diabetes Mellitus
renal threshold 2. Type-2 diabetes mellitus or
glucose. In such cases, the
blood glucose level noninsulin
insulin is often refered Diabetes complications can be divided
response

L.e., below normal renal

dependent diabetes mellitus (NIDDM) oduced sensitivity of
is below 180 mg%, perhaps due
appears in resistance. This is as acute and chronic complications. The
threshold for glucose, but glucose Type-1 Diabetes Mellitus to as insulin receptors on the cell
renal threshold. insulin complications of diabetes mellitus are less
due to lowered ioinadequate often
the urine
inherited Type-l diabetes is also called IDDM This syndrome is
Surlaces of the tissues. common and less severe in people who
Renal glycosuria may result fromacquired as juvenile-onsett diabetes. The patientsoftype-lor person.
defects in the kidney or it may
be found in an obese have well-controlled blood sugar levels. Its
glvcosuria diabetes mellitus are not obese
a result of kidney disease. Renal complications are described in the following
Onset
unrelated to diabetes, Cause sections.
is a benign condition, diabetes occurs after
Onset of the type-2
and it may occur temporarily in pregnancy I is caused by lack of insulin secretion due gradually.
develops
without symptoms of diabetes. to destruction of pancreatic beta cells. The age 40 and the disorder referred to as
Acute Complications
Therefore this syndrome is o Diabetic ketoacidosis (DKA): It is
destructions of ß cells may be due to: .onset diabetes.0 MDrdB generally seen due to low insulin levels.
Diabetic Glycosuria 1. Viral infection
Diabetic glycosuria is a pathological 2. Autoimmune disorder (destruction of Symptoms which favors lipolysis /n adipase tissu.
condition and is due to deficiency or lack symptoms are Increased lipolysis leads to increased
tissues by body's own antibodies). In tvpe-2 diabetes mellitus, the
of insulin, which causes diabetes mellitus. 3. There may be hereditary tendency for Bcell developed gradually which are similar to that mobilization of fatty acids from adipose
Although the renal threshold is normal, is usually not tissue to liver, where they are converted
as blood glucose level exceeds the renal
degeneration. of type-1 except ketoacidosis
mellitus.
present in type-2 diabetes
to ketone bodies (8-hydroxybutyrate and
threshold, the excess glucose passes into the Onset
urine to produce glycosuria. The usual onset of type-I diabetes occurs at Table 1.3:Comparisonof two types of diabetes mellitus.
about 14 years of age and for this reason it is Type-1 insulin-dependent Type-2 noninsulin-dependent
DIABETES MELLITUS called juvenile diabetes mellitus ("juvenile" Features
diabetes mellitus diabetes mellitus

means teenage in Latin). 5-10% 90-95%

Definition Frequency
Age of onset Early during childhood or Later after age of 40 years
Diabetes mellitus is a metabolic disease Symptoms puberty usually <20 years
characterized by hyperglycemia, caused by nIt develops symptoms very abruptly with: Abrupt and severe Gradual, insidious
inherited and/or acquired defects in insulin Onset of symptoms
" Polyuria (frequent urination) Plasma insulin Low or absent Normal to high
secretion, insulin action, or both. The chronic " Polydipsia (excessive thirst)
Low to normal Obese
hypergiycemia of diabetes is associated with " Polyphagia (excessive hunger) Body weight
long-tern damage, dysfunction, and failure of o These symptoms are accompanied by loss Blood glucose Increased Increased
different organs, especially the eyes, kidneys, of body weight, weakness, and tiredness. Insulin sensitivity Normal Reduced
nerves, heart, and blood vessels.
Hyperglycemia with glycosuria and Ketosis Common Rare
General symptoms of diabetes are due to ketoacidosis are the metabolic changes Acute complications Ketoacidosis Hyperosmolar coma
rise in blood sugar. The general synptoms of OCcur in type-1 diabetes mellitus. Treatment with insulin Necessary Usualy not required
 Alterations
Carbohydrates and its
of
The Metabolism
2 2 Chapter 1: initial managenent of Chapter 1: The Metaboism of Carbohydrates and its Alterations 23
levels of
ketone
NIDDM 0s
Elevated
blood's dietary therapy combined based on
physical activity, if possible. wih
acetoacetate).

blood decrease
the
measurements are less
reliable than bBood The urine test used may be referred to as the
bodies in the increased are not used to
insulin However, glucose measurements and
hypoglycemic drugs or "dipstick test" as it involves dipping a strip nto
pH teading toDKA. lack of insulin activity may be oral evaluate treatnent for
diagnose diabetes or the uriñe and reading the results using a color
iny pdiabetes i a : The
e r g l y c e mmellitus results in failure of in the presence of marked hyperglycinemia.
o
H

The goals of managing

gven diabetes. They may be used
for screening chart. A5trip will be dipped into the urine sample
fromthe blood into
cells diabetes
are to: purposes, Urine glucose can
also be analyzed during the test The different blocks of color
change indicate levels of glucose ketones, and
transfer ofglucose resultant
The o keepblood glucose levelss as neart undiagnosed. Urine
and leads to
hyperglycemia.
as possible by proper diet with to normal in the people who are protein in the urine.
the glucose renal of glucose by
is tested for the presence "dipstick
hyperglycemia exceeds
to glycosuria. The
andregular exercise. medication Benedict's qualitative test or
test.
Blood Glucose Estimation
threshold and leads o Maintain blo od
glvcosuria induces an
osmotic diuresis cholesterol and
consequently, leads to
loss of water
ceride (lipid) levels
ranges as possible.
as near
the trigly-
nomal
Ketone Test
ketones in
Blood glucose testing is more informative and
safer than urine testing.
and, This test detects the presence of
and electrolytes. o Control blood pressure. Blood from fat when Blood sugar level estimated at:
ketoacido tic coma: The urine. Ketones are formed
o Diabetic
ketoacidosis, should not go over 140/90. pressure there is insufficient insulin to allow
glucose o Any time of the day without any prior
result of severe
People with diabbetes ketones. preparations is knowTras random blood
used for fuel. At high levels of
combined
and
impaircerebral responsibility for their day- -to-daymust (o be
hyperosmolarity
and
electrolytes disturbance
hyperglycemia care. take
This ketoacidosis may occur.
sugar (RBS).
function, producing diabetic ketoacidotic includes monitoring blood glucose levels, Ketones can be detected by Rothera's o In the morning after an overnight fast of
or 8-12 hours is called fasting blood sugar
distinct from the dietary
management,
maintaining qualitative test (nitroprusside reaction),
coma) This is quite physical
and stysical into (FBS).
found activity, keeping weight by "dipstick test," by dipping a test strip
hypoglvcemiccoma that may also be control, monitoring oral medications, asample of urine. A color change on the
test a At2hours after ameal is called postlunch ar
is due to insulin and, i postprandial blood sugar (PLBS or PPBS).
in diabetic patients, which insulin use via injections or strip signals the presence of
ketones in the
entirely different required, pump. "Prandial" in Latin means after food."
over dosage, and has
clinical features.
urine.
most commonly in people An enzymatic method, using the highly
INVESTIGATIONS OF DIABETES Ketones occur
uncommonly, specific enzyme glucose oxidase, is
used for
Chronic Complications MELLITUS with type-1 diabetes, but diabetes the routine determination of blood glucose
people with ucontrolled type-2
complications may be presence level.
Chronic diabetes The following investigations are helpful in may test positive for ketones. The DFor the healthy individuals, normal
blood
blood vessels with diabetes may
due to damage to small diagnosis of diabetes mellitus: of ketones in a person sugar levels are as followvs (Table
I.):
(microvascular) or may be due to damage to o Urine testing indicate a high blood glucose level. Fasting (before meals): Between 72
and
larger blood vessels (macrovascular). o Blood glucose estimation
Microalbumin Test 99 mg/ dL
o Microvascularcomplications inciude o Glycated hemoglobin (HbAlc) estimation microalbumin, Postprandial blood sugar (2 hours after
damage to eyes](retinopathy)) leading O Glucose tolerance test (GTT) The microalbumin test detects
urine. Protein is meal): Up to 140 mg/dL
to blindness, to kidneys (nephropathy) a type of protein, in the damage to Random (any time of the dav):
Below
leading to renal failure, and to nerves Urine Testing present in the urine when there is 200 mg/dL.
blood vessels
(neuropathy) leading to impotence and Urine tests can be used for diagnosing and the kidneys. Since the damage to o For people with diabetes,
blood sugar level
complication of diabetes can
diabetic foot disorders (which include monitoring diabetes. Urine testing is Jess that occurs as a (diabetic targets are as follows (Table
1.4):
severe infections leading to anputation). accurate than blood testing but is useful as a lead to kidney problems disease is done " Fasting (before meals): 126
mg/dL or
nephropathy). The microalbumin test
D Macrovascular complications include screening test for people who already know to check for danage to the kidneys
over time, more.
sugar (2 hours ufter
cardiovascular diseases such as heart they have diabetes. In diabetes, urine is tested detected by Postprandial blood
The level of microalbumin can be meal): 200 mg/dL or nore.
attacks, strokes, and insufficiency in blood for the presence of three paraneters: urine dipsticks.
special albumin-specific
low to legs. J Glucose
Good metabolic control in both type-1 o Ketones Table 1.4: Criteria for dlagnosls of diabetes Diabetes
and type-2 diabetes can delay the onset and o Protein (micro-albumin) Blood glucose test Normal
200 mg/dL or more
progression of these complications. Below 200 mg/dL
Randor
Glucose Test Below 100 mg/dL
126 mg/dL or more
Management of Diabetes Mellitus Glucose is not normally found
in urine, but Fasting 200 ma/dL or more
Below 140 mg/dL
into the urine 2-hour postprandial
There is no cure for diabetes, but it can il can pass Irom the kidneys
be treated and controiled. deally, the in people who have diabetes. Urine glucose
 Carbohydrates and itsSAiterations
Metabolis
of
Chapter1:
The mg test tells about
average
over the past 2-3 months.level of
A day): 200 Chapter 1: The Metabolism of Carbohydrates and its Alterations 25
"
Random (any
time of the
a Estimation of
iblood sug
dL or more.
(HbAlclevels in t oOral GTT (0GIT) Diminished glucose tolerance or
Testing with
a GlucOse degree of bloodisUSed
as a guide to the
o Intravenous GTT (IV GTT) " Increased glucose tolerance
Blood Sugar
Aglucose meter is a portable electronic
long period. conttol over a
n An elevated HbAlc indicates poor conto Oral glucose tolerance test Normal glucose tolerance curve
Meter

approximate of blood glucose level

in 1The patient who is scheduled for OGTT is Normal response to glucose load is as follows:
months and can guide the
the instructed to eat a high carbohydrate diet o Initial fasting glucose is within the normal
the previous23
determining
Glucose
device for in the
blood.
for at least 3 days prior to the test, and come
concentration

meter
ofglucOse

measures sugar
level ina small
drop of
physician in
selection of appropriate treatment
after an overmight fast on the day of the test.
fasting limits (70- 100 mg%).
o Blood glucose level rises to a peak (120
pricking Glucose Tolerance Test Afasting blood glucose sample is first draw. 140 mg%) at half to l hour.
blood, obtained byw
blood.
small drop of
A placed on a
1 Then 75 g of glucose (or 1.75 g/kg body o The blood glucose level then returns
with a lancet, is In symptomatic cases,
the fingertip reads
glucose meter
the
be confârmed by finding diagnosis Can
weight) dissolved in 300 m of water is rapidly to the lasting normal limits in about
strip. The ingested. Blood and urine specimens are 2 hours.
disposable test

and uses to
calculate the blood
glucose level.
blood glucose concentration. glycosuria and z collected at half hourly intervals for at least D Glucose should not be present in any ofthe
The meter then
displavs level in units of
the glucose is directly proportional toFasting
o blood 2hours. Blood glucose content is measured urine specimens collected for 2 hours.
of diabetes mellitus. But the the
problemseveriarisesy
I and urine is tested for giucosuria.
mg dl. or mmol
in asymptomatic cases, which o Acurve is plotted for time against blood Diminished glucose tolerance
Glycated hemoglobin is aform of hemoglobin fasting blood glucose level but arehavesuspected
Glycated Hemoglobin Estimation
normal glucose concentration and is called glucose Diminished glucose tolerance means
to have diabetes on other tolerance curve. decreased ability of the body to utilize glucose.
The blood test for grounds. Such In diminished glucose tolerance,
that is bound to glucose. individuals are diagnosed by GTT.
people Intravenous glucose tolerance test
HbAlc level is routinely performed inmellitus. Glucose tolerance test is not
o Fasting glucose is higher than normal limits.
diabetes
with tvpe-land type-2
reflective of how well
in symptomatic or in necessaryof
known cases
o The IV GTT is often used for persons with o The blood glucose level rises above
Blood HbAlc levels are malabsorptive disorders or previous gastric 180 mg/100 mL (renal threshold) after
diabetes is controlled.
hyperglycemic patients. In such Cases or intestinal surgery. ingestion of glucose.
about
determination of fasting or
All above tests provide information postprandial
glucose is usually sufficient for the o Glucose is administered intravenously over D The blood glucose remains high for a
the patient's glucose concentration only at diagnosie 30 minutes using 20% solution. A glucose longer time and may not return to fasting
that time and may be unreliable of
overall
Definition load of 0.5g/kg of body weight is used. level even after 3 hours.

control. HbAlc is better than fasting glucose o The urine samples coresponding to blood
for determining the control on diabetes The glucosetolerance is the:ability of the body Types of Glucose Tolerance Curve glucose level over l80 mg/100 mLmay show
to utilize glucose. It is indicated by the oNormal glucose tolerance curve (Figure urine Benedict's test positive (glycosuria).
mellitus of a patient. hpe
o The RBCs of all people contain asmall of blood glucose curve after administration oi 1.17) o Diminished glucose tolerance occurs in
1 Abnormal glucose tolerance cuve may be diabetes mellitus and certain endocrine
proportion of HbAlc. The rate of its glucose. due to:
formation is proportional to the glucose disorders such as:
levels and so persons with diabetes have Importance of Glucose Tolerance Tect 250
a higher proportion of HbAlc than do 0 GTT is most important in the investigation
normal individuals.
" For people without diabetes, the normal
range for the HbAlc level is between 4
of asymptomatic hyperglycemia or
glycosuria such as renal glycosuria and
alimentary glycosuria.
(gBnluoc/dLse) 200+

150
Renal threshold
A Diminished glucose tolerance occur in
diabetes mellitus and endocnne hyperactvity

and 5.6%. T This test may contribute useful information

" HbAlc levels between 5.7 and 6.4% in some cases of endocrine dysfunctions. 100+
B Nomal
mean you have a higher chance of a Itis also helpful in recognizing milder cases 50 C Increased gluCOse tolerance, eg.in
getting diabetes. of diabetes.
endocrine hypoactivity
" Levels of 6.5% or higher mean you have 0
diabetes. Types of Glucose Tolerance Test 05 1 1.5
1 Once HbAlcformed, it remains within the Fasting
Glucose tolerance test can be perlormed by Hours
red cell for its lifetime, 120 days. HbAlc twO ways: Figure 1.17: The qlucose tolerance curves.
 Carbohydrates and its Alterations
Metabolism of
26 Chapter 1: The
Extended GTT is carried Chapter 1: The Metabolism of Carbohydrates and its Alterations7)
" Hyperthyroidism
out
ilyperpituitarism

(Cushing's syndrome)
a minimum 10 hours
of
water permitted. 75g of fasting fowilthowinonlg,y Nuising implication
" Hyperadrenalism
anhydrous
dissolved in 300--400 mL of gucose, Nurses should provide accurate and up-to-date inforrnat:on about the patient's condtion so that the
Increased glucose tolerance administered. Blood samples water, is orally healthcare team can come up with appropriate management. The nurse should assess thhe laboratory
increased
plasma cortisol and growth (for
Increased glucose
tolerance means
to utilize glucose.
In collected at 0 and 30
gucOse,are
hormone)
investiqation for patients with Diabetes Mellitus.
" Random blood glucose test: For a random blood giucose test, blocd can be drawn at any time
ability of the body
increased glucose tolerance, hours.
minutes intervals throughout the day, regardless of when the person last ate. Arandom blood glucose level of 200 mag
lower than normal. dL or higher in persons who have synptoms of high blood glucose suggests a diagnoss of diabetes.
aFasting blood glucose is glucose level may
Most normal subjects show
r0se in " Fasting blood glucose test: Fasting blood glucose testing involves measuring biood glucose after
n Only small rise in blood glucose followed I by afall to a base blood not eating or drinking for &to 12 hours (usually overnight). Anormal fasting blood glucose level sless
be observed (not >100
mg%) even after hours. Blood glucose of E45 line
at2 than 100 mg/dL Afasting blood glucose of 126 mg/dL or higher indicates diabetes. Thetest is done by
glucose administration. in blood cortisol and mg/dL and taking a small sample of blood from a vein or fingertip. It must be repeated on another day to confirm
obtained.
growth hormone leval that it remains abnormally high.
o A latter type of curve is occur with reactive hypoglycemia. o Hemoglobin A1C test (HbA1C): The HbA1C blood test measures the average blood qlucose level
in urine.
o No appearance of glucose during the past two to three months. It is used to monitor blood glucose control in people with known
o This type of curve is
obtained in endocrine Mini Glucose Tolerance Test diabetes, but is not normally used to diagnose diabetes.Normal values for HbA1C are 4 to 6 percent.
hypoactivity such as: As per current The test is done by taking a smali sample of blood from a vein or fingertip.
recommendations of WHO " Urine is tested for the presence of three parameters: glucose, ketones, and protein (microalburnin)
" Hypothyroidisn (myxedema, cretinism) mini or modern GTT, only two
samples ae
Hypoadrenalism (Addison's disease) " Oral glucose tolerance test: Oral glucose tolerance testing (0GTT)is the most sensitive test for
collected.
diagnosing d1abetes and pre-diabetes. However, the OGTT is not routinely recommended because it
" Hypopituitarism 1. Fasting (0 hour) is inconvenient compared to a fasting blood glucose test. Oral glucose tolerance testing is routinely
" As per the WHO, people with fasting glucose 2. 2-hour post glucose load performed at 24 to 28 weeks of pregnancy to screen for gestational diabetes.
levels from 110 to 125 mg/dL are considered to Urine samples are also collected durine
have impaired fasting glucose. the samne time. The diagnosis is made from HYPOGLYCEMIA that release excess amounts of insulin, and
" People with plasma glucose at or above 140 prediabetes.
variationsobserved in these result.
mg/dL but not over 200 mg/dL 2 hours after a Hypoglycemia refers to low levels of sugar, or o In some patients, symptoms of hypo
75-g oral glucose load are considered to have
Glucose Challenge Test (GCT) glucose, in the blood. Hypoglycemia is not a glycemia occur during fasting (fasting
impaired glucose tolerance. disease, but it can indicate a health problem. hypogBycemia).
The glucose challenge test measures body's Hypoglycemia is a fall in blood sugar to levels a In others, symptoms of hypoglycemia
Glucose Tolerance Test Performed in response to sugar (glucose). The glucose below normal. occur after meals (reacive hypoglycemia)
challenge test is done during pregnancy to Hypoglycemia may result in a variety of This is different from low blood sugar
Specific Conditions in Diabetics
screen for gestational diabetes. Gestational symptoms including: (hypoglycemia) that occurs while fasting.
Glucose tolerance test performed under diabetes is the diabetes that develops during
n Feeling of hunger o However, yet another type of hypoglycemia
special conditions are: pregnancy. The test is generally done between o Tremor or shaky is drug induced which occurs in patients of
D Extended GTT
24 and 28 weeks of pregnancy. o Sweating diabetes mellitus who are either on insulin
o MiniGTT n A
pale face
Procedure: After arriving a laboratory, or oral hypoglycemicdrugs.
oGCT (glucose challenge test) about I50 mL of glucose solution that 1 Heart palpitations It is commonly thought that fasting
contains 75 g of sugar is given orally to a a Dizziness andweakness hypoglycemia is a serious condition, whereas
Extended Glucose Tolerance Test reactive hypoglycemia is invariably a benign
o Blurred vision
pregnant woman without regard o lhe
Extended GTT is the 0GTT extended to Lack of glucose energy to the brain can
time of last meal, Avenous blood sample is disorder.
4-5 hours. It is performed to diagnose the collected at 2 hours for estimating plas cause symptoms ranging from headache,
cause of hypoglycemia especially which glucose, Results of the glucose chalens mildconfusion, and loss of consciousness, Treatment
occurs 2-3 hours after meal, called reactive seizure,and coma. Severe hypoglycemia can Treatrnent must also be focused at the basic
test are given in ng/dL.
hypoglycemia. Reactive hypoglycemia Gestational diabetes mellitus is diagnosed cause death. cause.
produces hypoglycemia in the postprandial if 2-hour plasma glucose is 140 mg/dl. or o Immediate treatment of severe hypoglycemia
(fed) state. Extended GTT is not useful in higher. Ablood sugar level below 140 mg/dL Causes consists of administration of large amounts
The causes of hypoglycemia include use of of glucose and repeating this treatment at
fasting hypoglycemia. is considered normal. drugs (such as insulin), liver disease, tumors intervals if the symptoms persist.
 Alterations
Carbohydrates and its
Metabolism of
2R Chapter
1: The
hypoglycemia fewer concentrated
muliple small meals Sweets and Chapter 1: The Metabolism of Carbohydrates andits Alterations 29
reactive
of
Treatment
including eating
o
involves changing the diet,
throughout 3. In which form Glucose is stored in animals?
a. Starch b. Glycogen
a. Co, is not produced in it
b. NADPH is produced
ASSESSMENT QUESTIONS c Dextrins d. Cellulose c Pentoses are produced
4, Which of the following is a constituent of milk? d. Does not produce ATP

Long-Answer Questions
Very Short Answers a. Xylose b. Lyxose 17. Gluconeogenesis occurs predominantly from
c. Xylulose d. Galactose the following compounds, except:
classify
carbohydrates 1, Write any four functions of à. Lactate b. Palmitic acids
5. Which of the following is a non-reducing
1. Define
carbohydrates;

examples and their

functions.
of
2. Name any four
glycosaminoglycans.
carbohydrates
different sugar:
c Glycerol d. Amino acids
with digestion and absorption
3. Name
types d a. Arabinose b. Erythrose 18. How many ATP molecules are produced on
2. Describe enzymes involved d. Ribulose complete oxidation of acetyl CoA in the citric
in c. Sucrose

3.
carbohydrates.

Describe the path

way of glycolysis,
and its carbohydrate.
4. Define glycolysis.
digestlion o 6. Table sugar is: acid cycle?
a. Six b. Nine
significance and energetics. a. Starch b. Glucose
pathway of citric acid
cycle, and its 5. Define gluconeogenesis. c. Fructose d. Sucrose C ten d. Fifteen.
Describe the 6. What is the end 19. Which of the following enzyme is not involved
4. significance and energetics. product of anaerobic 7. A disaccharide produced on hydrolysis of
5. Describe different
types of diabetes
mellitus Why?
7. Why TCA cycle is called amphipathic)
cglycohys starch is called: in gluconeogenesis?
a. Pyruvate carboxylase
related to diabetes mellitus. a Sucrose b. Lactose
and investigations gluconeogenesis and 8. Draw Coricycle. c Maltose d. Trehalose b. Phosphoenol pyruvate
6. Descritbe the pathway of 9. Name any two glycogen c Carboxykinase
storage diseaser 8. Which of the following monosaccharides is d. Hexokinase.
its significance.
metabolism and its defective enzymes. not an aldose?
glycogen 20. The most important initial source of blood
7. Describe the 10. Define pentose phosphate pathway, a. Ribose b. Fructose
significance. d. Glyceraldehyde glucose during fasting is:
phosphate pathway and 11. Write any two significance of HMP pathgy c. Glucose a. Muscle glycogen b. Muscle protein
8. Describe the pentose 12. What is hyperglycemia? Give one condmie - 9. A carbohydrate found in DNA is:
its significance. c Liver Triglyceride d. Liver glycogen
b. Deoxyribose
sugar level? Describe the which hyperglycemia occurs. a. Ribose 21. Von Gierke's disease is characterized by
9. What is normal blood requlation. 13. Name hormones involved in regulatlon of bld c Ribulose d. All of these
deficiency of the enzyme:
various mechanisms of its 10. Mucopolysaccharide is:
glucose level. a. Glucokinase
a. Hornopolysaccharides
14. Define glycosuria. Glve renal threshold y b. Glucose-6-phosphatase
Short Notes b. Heteropolysaccharides c Phosphoglucomutase
glucose.
1. Glycogen or animal starch. 15. Define diabetes mellitus. Glve normal vale d
c. Proteins
d. Glycogen synthase
d. Armino acids
2. Disaccharide.
blood glucose level. examples 22. Both glycolysis and gluconeogenesis involve
3. Functions of carbohydrates. 11. Lactose, sucrose, and maltose are all which of the following enzymes:
4. Mucopolysaccharidoses.
16. Name different types of diabetes melltus wie of: a. Pyruvate carboxylase
any two differences. a. Monosaccharides b. Disaccharides
5. Glycogen storage diseases.
b. Hexokinase

6. Glucosuria. 17. What are the symptoms of diabetes melltu! c Polysaccharides d. Oligosaccharides c Aldolase
7. Glucose tolerance test. 18. Which are the parameters are ínvestigated b 12. Which mammalian cell does not have
aerobic d. Phosphofructokinase

8. Lactic acid or Cori cycde. the diagnosis of diabetes mellitus? pathway of glucose catabolism? 23. In contrast to liver, muscle glycogen does
9. Significance of HMP
19. Draw normal GTT curve. à. Liver cell b. Adipose cell not contribute directly to blood glucose level
10. Ivestigations of diabetes mellitus. 20. Which are the different types of GTT? C. Nerve cell d. Red cell because:
21. What is HbA,c? 13. The end product of aerobic glycolysis is: a. Muscles lack glucose 6-phosphatase
11. Hypoglycemia. b. Pyruvate b. Muscles contain no glucokinase
a. Lactate

c. Acetyl-CoA d. CO, and H,0 c Muscles lack glycogen

glycolysis is: d. Muscles contain no glycogen phosphorylase
MULTIPLE CHOICE QUESTIONS(MCQs) 14. The end product of anaerobic
a. Lactate. b. Pyruvate. 24. Which of the following statement
is true
which two sugars C. Acetyl- CoA d. CO, and H,0 regarding a-amylase?
1. Which of the following is a simple sugar or 2. Maltose is composed of a. Breaks glucose from one
end of the
monosaccharide? a. Glucose and Glucose 15. Normal blood glucose level is:
a. 70-100 mg/dl b. 100-150 mg/dl carbohydrate
a. GalactOSe b. Lactose b. GluCose and Galactose d. None of the above b. Cleaves only u-1,4 linkages
Glucose and Fructose
C. 150-200 mg/dl
c Maltose d Sucrose . c Cleaves only a-1,6 linkages
d. Fructose and Galactose 16. Which of the following statements is not true d. All of the above
of HMP shunt pathway?
 Alteratione

Carbohydrates
and its
of
1: The
Metabolism
c Supplies ribose-5-phosphate
Chaoter h y p e r g l y c e m i c

20
hormones
have d. Converts glucose to galactose
folowing
27. Glucose-6-phosphate issinvolved
i Inv

2
25. The
effect, except: b. Thyroid
the following pathways:
a. Glucagon
c Epinephrine
d. Insulin

of
pentose
a. Glycolysis
The Metabolism of Lipids
functions b. Gluconeogenesis
following are the a n d its Alterations
26. The
phosphate pathway, except: c. Pentose phosphate pathway
pentoses
hexoses and
d. All of the above
Interconverts

a.
b. Produces NADPH

Content
Learning outcomes
Unit
Definition, classification
and functions of lipids
acids
and functions of fatty
Explain the metabollsm

* Definition, classification fatty

of lipids and its
monounsaturated
sígnificance of
Definition and clinical acids (PUFA)
alterations
polyunsaturated fatty
acids (MUFA), and fatty acids, and
significance of essential
Definition and clinical
trans fatty acids
Digestion, and absorption of
lipids
related disorders
Metabolism of lipids and
Compounds formed
from cholesterol
and significance
Ketone bodies, name, types
Lipoproteins,types and functions
Atherosclerosis

Lipid profile

Classification of Lipids
INTRODUCTION used classification
The most commonly
occurring water insoluble
Lipids are naturally predominance of lipids is as lollows:
substances. Due to 1. Simple lipids
hydrocarbon chains in their structure, lipids 2. Complex or compound lipids
lipids are
have hydrophobic nature. Some 3. Derived lipids
whereas others are the
vital energy reserves,
of biological simple Lipids
primary structural componentsdescribes the acids with va
membranes. This chapter These are esters of fatty
and functions of the type of alcc
structures, properties, alcohols. Depending on the
organism
major lipidclasses found in living these are subclassified as:
and their metabolism. Neutral fats or triacvlglycerol or trig
1.
ides
DEFINITION, CLASSIFICATION,
2. Waxes
LIPIDS
AND FUNCTIONS OF
Neutral Fats or Triacylglycerol or
Definition
substances
Triglycerides
Lipids may be defned as organic These are esters of fatty acids
with a
but soluble in organic
insoluble in water tripalmitin. Because tl
ether, and glycerol, e.g.,
solvents such as chloroform, are termed neutral !
Answers
9. b
10 D
benzene. They are esters of
fatty acids with uncharged, they
8, b eat are mostly triglycerides.
1. a 2. a 3. b 4, d 5. C 6. d 7. C 20.d the living fats we
18. c 19. b alcohol and are utilizable by liquid state is called oil, e.g.,
vegeta
11. b 12. d 13. b 14 a 15. a 16. a 17, b
organism.
21. b 22. C 23. a 24. b 25. d 26. d 27. d