Glucose Tests, Gluconeogenesis, & Pentose Phosphate Pathway PDF

(004) GLUCOSE TESTS, GLUCONEOGENESIS, PENTOSE PHOSPHATE PATHWAY, & OTHER CHO METABOLISM DR. VIESTA | 10/20/2020 OUTLINE I. GLUCOSE TESTS A. Types of Diabetes Mellitus B....

(004) GLUCOSE TESTS, GLUCONEOGENESIS, PENTOSE PHOSPHATE PATHWAY, & OTHER CHO METABOLISM DR. VIESTA | 10/20/2020 OUTLINE I. GLUCOSE TESTS A. Types of Diabetes Mellitus B. Blood Glucose Testing 1. Diagnostic Criteria of Diabetes 2. Types of Test a) Plasma Glucose Levels b) Oral Glucose Tolerance Test c) Hemoglobin A1c d) Insulin Test e) D-Xylose Absorption Test II. GLUCONEOGENESIS III. PENTOSE PHOSPHATE PATHWAY A. Interplay of Glucose and PPP IV. GLUCOSE-6-PHOSPHATE DEHYDROGENASE A. Clinical Presentation B. Therapy for G6PD deficiency - Most common type of DM. - IT develops gradually without obvious symptoms - However, many individual manifest signs and symptoms such as POLYURIA, POLYDIPSIA, POLYPHAGIA (3P’s) I. GLUCOSE TESTS Gestational Diabetes Mellitus A. Types of Diabetes Mellitus - variation of diabetes that some women Type 1 Diabetes Mellitus develop during pregnancy, most often Formerly known as INSULIN DEPENDENT around week 24 DIABETES MELLITUS - after the baby is born, most women’s - is an autoimmune condition which the blood sugars return to normal. body attacks insulin-producing cells in >Hormonal inhibition, allosteric inhibition: how insulin inhibits glucose the pancreas, making it impossible for them to produce insulin. - managed with Insulin therapy and B. Blood Glucose Testing lifestyle changes. BLOOD GLUCOSE TESTING: why, when, and - Insulin-dependent how - Characterized by an absolute deficiency Measures the amount of sugar called glucose in a of insulin caused by an auto-immune sample of your blood. attack on the Beta cells of the pancreas. Glucose is a major source of energy for most cell - PHYSIOLOGY: Islet of Langerhans of the body, including brain cells →infiltrated with activated T lymphocytes → INSULITIS. Long due, this Diabetes is a disease in which your blood sugar autoimmune attack will lead to gradual levels are too high. Overtime, having too much depletion of beta cells. glucose in your blood can cause SERIOUS - Patient with Type 1 DM have virtually no PROBLEM. functional Beta cells, and can neither If you are diabetic, self-testing your blood sugar respond to variations in circulating fuels can be an important tool in managing your nor maintain a basal secretion of insulin. diabetes and preventing complications Blood sugar testing provides useful information for Type 2 Diabetes Mellitus diabetes management. It can help you: Formerly known as NONINSULIN DEPENDENT - Monitor the effect of diabetes DIABETES medications on blood sugar levels - is categorized by a buildup of glucose - Identify blood sugar levels that high (sugar) in the bloodstream, caused by and low the body’s inability to use insulin - Track the progress in reaching your properly. - overall treatment goals - is characterized by hyperglycemia, - Understand how other factors, such as insulin resistance and relative illness or stress, affect blood sugar impairment in insulin secretion levels Type 1 diabetes - - Most common treatment is diet, exercise, and oral medication, but some cases may also require insulin. - Non-insulin dependent; there are Type 2 Diabetic who are insulin dependent PREPARED AND EDITED BY: TRANS GROUP 6  (004) GLUCOSE TESTS, GLUCONEOGENESIS, PENTOSE PHOSPHATE PATHWAY, & OTHER CHO METABOLISM DR. VIESTA | 10/20/2020 DIAGNOSTIC CRITERIA OF DIABETES This is aside from Type 1 and type 2, there are other type of DM classification the: - IMPAIRED METABOLISM OR PRE-DIABETES 1. IMPAIRED GLUCOSE TOLERANCE (IGT) - where blood glucose levels are higher than normal but not high enough to be classified as diabetes 2. IMPAIRED FASTING GLUCOSE (IFG) - where blood glucose levels are escalated The frequency of testing usually depends on the type of in fasting state but not high enough to be your diabetes you have and your treatment plan classified as diabetes And if you are type 1 diabetes recommended blood sugar testing 4 to 10 times a DAY. You need to test: - Before meals and snack - Before and after exercise - Before bed - During the night sometimes - More often if you’re ill - More often if you change your daily routine - More often if you start new medications And if you take insulin + type 2 DM several times a day depending on type and amount of insulin you use: - Before meals and at bedtime if you’re taking multiple daily injection - Before breakfast and dinner if you use just an intermediate-or long acting insulin And if you manage type 2 DM with noninsulin medication or with diet and exercise alone. - Not need to test your blood sugar daily Target blood glucose level - Most doctors set target blood sugar test based on several factors 1. Type and severity of disease TYPES OF TEST 2. Age A. PLASMA GLUCOSE LEVELS 3. How long you’ve diabetic 4. Pregnancy status The American Diabetes Association reports that 5. The presence of DM complications the Fasting Plasma Glucose (FPG) for normal 6. Overall health and the presence of other individuals should be Malate in mitochondria Oxaloacetate, pyruvate (from alanine) is also a precursor Malate –> Oxaloacetate from mitochondria to cytoplasm In order to cross the mitochondrial membrane, oxaloacetate must: - Be reduced to malate - Go through the malate-aspartate shuttle - Be reoxidized to oxaloacetate Enzyme (1) malate dehydrogenase -> NADH (mitochondria), (2malate dehydrogenase) -> NAD+ (cytoplasm) Three important irreversible reactions in glycolysis: - Reaction 1 (enzyme: hexokinase) - Reaction 3 (enzyme: phosphofructokinase) - Reaction 10 (enzyme: pyruvate kinase) (2) Enophosphopyruvate carboxykinaase – locates in both cytosol and mitochondria. So there are two ways to transfer pyruvate to PEP. PREPARED AND EDITED BY: TRANS GROUP 6  (004) GLUCOSE TESTS, GLUCONEOGENESIS, PENTOSE PHOSPHATE PATHWAY, & OTHER CHO METABOLISM DR. VIESTA | 10/20/2020 Pyruvate This is primarily a function of the liver to buffer blood glucose levels. Glucose-6-Phosphatase is NOT present in brain and muscles! PREPARED AND EDITED BY: TRANS GROUP 6  (004) GLUCOSE TESTS, GLUCONEOGENESIS, PENTOSE PHOSPHATE PATHWAY, & OTHER CHO METABOLISM DR. VIESTA | 10/20/2020 III. PENTOSE PHOSPHATE PATHWAY The pentose phosphate pathway is an alternative route for the metabolism of glucose. It does not lead to formation of ATP but has two major functions: (1) the formation of NADPH for synthesis of fatty acids and steroids and maintaining reduced glutathione for antioxidant activity, and (2) the synthesis of ribose for nucleotide and nucleic acid formation. Has several important roles: 1. Provide away for our cells to oxidize glucose to create NADPH- contain a phosphorylated 2’OH group on one of the ribose unit. A NADPH is different from NADH because it contains another phosphate group. NADPH is used as reducing agent