Clinical Chemistry Exam 2 Review Carbohydrates

Which 3 chemicals, in general, make up carbohydrates?
Carbon
Hydrogen
Oxygen
Are Monosaccharides simple or complex carbon chains?
Simple
In monosaccharides what is the type of bond between oxygen molecules?
Glycoside
What type of carbohydrates are the following considered:
Fructose
Glucose
Galactose
Monosaccharides
True or False:
Monosaccharides are readily absorbed by intestines from diet
True
Define the following:
Disaccharides
2 monos join with the release of a water molecule (glycosidic bond)
True or False:
Disaccharides are broken down by enzymes in intestines, then absorbed as monos
True
What type of carbohydrates are the following considered:
Maltose
Lactose
Sucrose
Disaccharides
Define the following:
Oligosaccharides
2-10 Monosaccharides
Define the following:
Polysaccharides
>10 monosaccharides
What type of carbohydrates are the following considered:
Starch
Glycogen
Polysaccharides
True or False:
Polysaccharides are the primary dietary source of carbohydrates
True
What begins the process of digestion?
Salivary Amylase
What two enzymes break down complex sugars into monos which are absorbed into blood?
Pancreatic amylase
Intestinal maltase
_____ travels to liver or directly into tissues for energy use or storage
Glucose
Other monos first travel to what organ where they are converted into glucose.
Liver
Glucose can be stored in liver and muscles as what?
Glycogen
True or False:
Glucose is a primary energy source
True
Glucose cannot be stored where?
Brain or nervous tissues
Once Glucose enters a cell it is converted to what?
glucose-6-phosphate
How does glucose enter a cell?
Facilitated Diffusion
What does Glucose require to convert into glucose-6-phosphate?
Hexokinase
What type of glycolysis does the following occur:
G6P is converted to pyruvate with production of lactate and 2 ATP
Anaerobic
What is the following called:
When O2 is plentiful, pyruvate converts to acetyl coenzyme A and enters the Kreb’s cycle to create ATP, CO2, and H2O
Aerobic Oxidation
Describe Hexose Monophosphate Shunt
Production of ribose and NADPH which protects cells from free radical damage;
Ribose used for nucleic acid formation.
True or False:
HMP shunt is an important energy source for red cells
True
Define the following: Glycogenesis
When Energy needs are low and glucose is in excess, G6P converts into glcogen for storage
Define the following: Glycogenolysis
When the body needs energy, the liver can convert glycogen back to glucose and release it into the circulation
Define the following: Gluconeogenesis
Formation of glucose from AA, Ketones, Lactate, Glycerol, and other non-CHO sources during times of fasting.
What is Gluconeogenesis associated with?
Ketosis
Describe Lipolysis
In time of starvation, lipids can supply energy by the production of ketones through the Kreb’s cycle
What organ is the primary consumer of ketones?
Brain
Define the following: Lipogenesis
Excess glycose can contribute to production of fats
What are the 3 sources of Glucose?
Food
Stored Glycogen
Gluconeogenesis
Insulin is secreted by the pancreas in response to what?
Elevated Plasma Glucose
Glucagon is secreted by the pancreas in response to what?
Decreased Plasma Glucose
What kind of hormone is Epinephrine?
Adrenal
Epinephrine ____ plasma glucose rapidly during times of stress
Raises
What kind of hormone is Cortisol?
Adrenal
Cortisol ____ plasma glucose
Raises
What other substances can raise plasma glucose?
GH
ACTH
Thyroxine (T4)
Somatostatin
Insulin is the only _______ agent
Hypoglycemic
How does Insulin DECREASE plasma glucose?
Accelerating uptake of glucose into cells
Triggering glycolysis, glycogenesis, and lipogenesis synthesis
Glucagon is secreated by the pancrease in what times?
Fasting or stress
Glucagon is what type of agent?
Hyperglycemic
How does Glucagon RAISE plasma glucose?
Promoting glycogenolysis, gluconeogenesis, and lipolysis
Does Insulin Increase or Decrease plasma glucose?
Decrease
Does Glucagon Increase or Decrease plasma glucose?
Increase
What is the reference range of Carbohydrate Metabolism?
70-110 mg/dL
What is the range for Hyperglycemia?
Fasting>110 mg/dL
What is the range for Hypoglycemia?
<60 mg/dL
What does High Blood Glucose result from?
Defects in insulin production, insulin action, or both.
Diabetes-related complications are the leading cause of what -related deaths?
Heart Disease or Stroke
What is Diabetes the leading cause of?
Blindness
Kidney Failure
Non-traumatic limb amputations
Nerve Damage
Type I – What is Absolute Insulin Deficiency due to?
Destruction of pancreatic cells
Is Type I or Type II considered an autoimmune disease?
Type I
What is the age range for Type I (generally)?
Juvenile-Adolescence
Does Type I occur suddenly?
Yes
Is Type I or Type II considered insulin dependent?
Type I
Ketosis
Decreased pH, Hyperventilation, Confusion, Coma
What 3 diseases are associated with Type I Diabetes Mellitus?
Kidney
Eye
Heart
In Type I or Type II will you see the following:
Polydipsia, polyuria, weight loss
Type I
Is Type I or Type II considered to have insulin resistance/insulin secretory defect?
Type II
What age goes with Type II (generally)?
Adult onset
(becoming more frequent in kids)
Which Type of Diabetes has the following:
Stronger genetic basis, race, ethnicity factors
Type II
How can Type II be controlled?
Diet
Weight Control
Exercise
Oral Medicine
What percentage of Type II Diabetics will become insulin dependent?
16%
What are the diseases associated with Type II Diabetes Mellitus?
Microvascular disease;
Risk of eye, heart disease/stroke, and kidney problems
Type II: Nonketotic hyperosmolar coma (>_____ mg/dL)
1000
Which diabetes has an onset during pregnancy?
Gestational
Gestational Diabetes Mellitus is what percentage of all pregnancies?
2-3%
It is believed that what placental hormone inhibits insulin?
Lactogen
True or False:
Women who obtain Gestational Diabetes Mellitus have a higher chance of developing diabetes later
True
What diseases are associated with the infants of women who suffer Gestational Diabetes Mellitus?
Macrosomia
RDS
Hypoglycemic shock
What is the mg/dL fasting concentration for pre-diabetics?
100-125
What is the mg/dL post prandial concentration for pre-diabetics?
140-199
What are 3 other causes of hyperglycemia?
Malignancies of pancreas
Liver Disease
Drugs
When do symptoms of hypoglycemia occur?
50-55 mg/dL
When do convulsions and coma occur at for hypoglycemia?
20-30 mg/dL
After 20 minutes of convulsions due to hypoglycemia what will occur?
Brain damage or death
What will stimulate glycogenolysis and inhibit insulin?
Glycagon
Epinephrine
Cortisol
GH
Symptoms of Hypoglycemia?
Hunger
Shakiness
Increased heart rate and bp
sweating
nausea
blurring vision
confusion
Causes of Hypoglycemia
Insulin overdose
Insulin shock due to insulin producing tumors
Drug interactions
Predisposing illness or hospitalization
Extreme exercise
Panic Values?
<50
>450
Reference Range for:
Fasting Serum or Plasma
70-110
Reference Range for:
Whole Blood
65-95
Reference Range for:
Neonate
50-100
Reference Range for:
CSF
40-70
Reference Range for:
Urine, random
Negative
Reference Range for:
Renal Threshold
160-180
What color top will have sodium fluoride plus potassium oxalate
Gray/Grey Top
True or False:
Sodium Fluoride is the specimen of choice for whole blood testing or if testing will be delayed
True
What does Sodium fluoride inhibit?
Glycolysis
What color top do you use for plasma testing?
Green (Heparin)
Serum/plasma with no perservative, separated from cells: Glucose is stable for how long at RT?
8 hours
Serum/plasma with no perservative, separated from cells: Glucose is stable for how long at 4 degrees Celsius?
72 hours
Unpreserved whole blood: Glucose will decreased by _____ per hour at RT
12%
Random Glucose: What concentration plus the class symptoms of diabetes is diagnostic
> or = 200 (x 2)
Fasting Plasma Glucose: What concentration is diagnostic for diabetes?
>126 mg/dL
Fasting Plasma Glucose: What concentration is impaired for diabetes?
10-125 mg/dL
What is the recommended screening in all asymptomatic people >45 years of age?
Fasting Plasma Glucose
2 Hour Post- Prandial: What concentration is diagnostic for diabetes?
> or = 200 mg/dL
Is OGTT recommended for routine use?
No
OGTT is for diagnosis in patients who have what type of fasting levels?
Borderline
The OGTT is never warranted if fasting is >_____
126
OGTT: What concentration is diagnostic for diabetes at 2 hours?
> or = 200 mg/dL
3 Hour OGTT for what type of diabetes?
Gestational
What reflects the average blood glucose concentration for the preceding 3 months?
Glycosylated Hemoglobin
HbA1C
What specimen is needed for HbA1C?
EDTA
What is the normal range for HbA1C?
4-6%
What can cause a false negative HbA1C?
Anything causing a shorter RBC lifespan
What can cause a false positive HbA1C?
Patients receiving erythropoietin or have gotten a blood transfusion
What are the 2 current testing methods for Glucose?
Glucose Oxidase Method
Hexokinase Method
What does the Glucose Oxidase Method measure?
Chromogen produced OR
Amount of O2 Consumed (polargraphic)
False Negatives for the Glucose Oxidase Method?
Uric Acid
Ascorbic Acid
Bilirubin
False Positives for the Glucose Oxidase Method?
Aspirin
Acetaminophen
Caffeine
Hexokinase Method measures absorbance of NADPH at _____
340 nm
Which Test is more specific Hexokinase or Glucose Oxidase?
Hexokinase Method
False Negatives for the Hexokinase Method?
Hemolysis
Bilirubin
Urine Glucose will be positive when what happens?
Renal threshold has been exceeded
A positive for Urine and Serum ketones is considered what?
Panic Value
Urine and Serum Ketones can be seen in what conditions?
Uncontrolled diabetes
Fasting/Starvation
Vomiting
Microalbumin is used to assess what?
early renal disease BEFORE the onset of proteinuria
What else will you find for Diabetic patients?
High urine SG
Proteinuria
Microvascular renal disease
Yeast infections and nervous system impairment
Will you see High or Low osmolality/dehydration in Diabetic patients?
High osmolality/dehydration
Serum Ketones lead to what?
Acidosis, hyperventilation, vomiting, and coma
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