Carbohydrates are major constituents of physiologic systems.

They are organic compounds composed of carbon, hydrogen , and oxygen [Cx(H2O)y], which,
along with lipids and proteins, provide energy and contribute to the structure of organisms.

Carbohydrates are polyhydroxyl aldehydes or ketones that, on hydrolysis, yield one of

these compounds. Carbohydrates are a major source of energy for the body, and starch is
the major source of carbohydrate.
1. Classification is based on the structure of carbohydrates.
a. Monosaccharides are simple sugars that contain four to eight carbons and only

one aldehyde or ketone group. These are reducing sugars (i.e., they can give up
electrons). Examples include glucose and fructose.
b. Oligosaccharides are formed by the interaction of two monosaccharides with the
loss of a water molecule and are sometimes referred to as disaccharides. Examples
include maltose, lactose, and sucrose.
c. Polysaccharides are formed by interactions between many units of simple sugars.
Examples are starch and glycogen.
2. Carbohydrate metabolism begins in the mouth.
a. Salivary amylase breaks down ingested starches into disaccharides, and these are

further broken down into monosaccharides by disaccharides and absorbed into

intestinal cells.
b. Monosaccharides are then transported to the liver and converted to glucose. Some
glucose is released into the blood, and the rest is stored as glycogen in the liver and
skeletal muscle.
c. Glycogenesis is the process of glycogen formation by enzyme action on glucose
to eventually form glycogen.
d. Glycogenolysis is the breakdown of glycogen, with the eventual formation of
glucose-6-phosphate or free glucose that can be used for energy production.
e. Glycolysis is the catabolism of glucose to pyruvate or lactate for adenosine triphosphate
(ATP) production (Embden-Meyerhof pathway and Krebs cycle).
f. Gluconeogenesis is the formation of glucose from amino acids and lipids that
occurs when carbohydrate intake decreases.
3. Factors that affect glucose levels include:
a. Insulin, which is a pancreatic hormone that decreases glucose levels by increasing

cellular uptake of glucose and promoting glycogenesis and lipogenesis (formation

of fat from carbohydrates)
b. Glucagon, which is a pancreatic hormone that increases glucose levels by stimulating
glycogenolysis and gluconeogenesis
c. Epinephrine, which is an adrenal hormone that elevates glucose levels
d. Growth hormone and adrenocorticotropic hormone (ACTH), which are pituitary
hormones that increase glucose levels
e. Glucocorticoids (e.g., cortisol), which are adrenal hormones that increase gluconeogenesis
and eventually elevate blood glucose
f. Thyroid hormones, which stimulate glycogenolysis and increase blood glucose
levels
4. Glucose disorders depend on serum glucose levels.
a. Hyperglycemia occurs when the fasting blood sugar level rises higher than

110 mg/dL due to a pathologic disorder, such as diabetes mellitus or liver failure.
b. Hypoglycemia occurs when the fasting blood glucose level is <70 mg/dL. This
typically occurs as a result of hormone deficiency, drug reaction, insulin excess (as
in insulinoma), or a genetic disorder.
c. Glycosuria (sugar in the urine) occurs when the renal threshold for glucose is
exceeded (160180 mg/dL) during hyperglycemia.
d. Diabetes mellitus is a genetic disorder of glucose metabolism that results in insulin
deficiency and lack of carbohydrate tolerance. There are two classifications:
(1) Type 1, formerly insulin-dependent diabetes mellitus. The individual
presents in an acute state with hyperglycemia and ketosis. This type is caused
by an autoimmune destruction of pancreatic cells and is usually juvenile
onset. However, onset is often around the age of 20.
(2) Type 2, formerly non-insulin-dependent diabetes mellitus. This is a
multifactorial disease with possible causes including genetics, environment
(lifestyle), and autoimmunity. One cause of onset is thought to be cellular
resistance to insulin or decreased insulin receptors on cell surfaces. Most individuals
with this disorder are obese or overweight, and onset is typically during
adulthood
.
5. Methods of glucose analysis include:
a. Glucose oxidase methods. Glucose is oxidized to gluconic acid and hydrogen
peroxide to eventually form a colored product. Falsely low results are caused by
high serum levels of uric acid, bilirubin, or ascorbic acid.
b. Hexokinase methods. Glucose becomes phosphorylated and dehydrogenated to
eventually form NADPH.
c. o-Toluidine (nonenzymatic method). o-Toluidine reacts with glucose in acetic
acid to form a colored product. Falsely elevated glucose values are obtained by
interference of mannose and galactose, whereas bilirubin induces a false decrease
in glucose values.
d. Glycated hemoglobin methods. The presence of glycated hemoglobins is examined
in diabetic patients. This test examines a patients compliance with an
insulin therapy regimen over a period of 8 to 10 weeks. Glycated hemoglobins
are formed when a glucose is attached to the N-terminal valine residue of either
chain of the hemoglobin A molecule. Hemoglobin A1 (made up of several minor
hemoglobins) is termed a fast hemoglobin based on its electrophoretic migration.
Glycated hemoglobin is separated from nonglycated hemoglobin by affinity chromatography.
Interferences include the presence of hemoglobin S and hemoglobin
F and may produce increased or decreased glycated hemoglobin values depending
on the specific methodology used.
6. Glucose metabolism tests examine a patients ability to metabolize glucose.
a. Glucose tolerance test (GTT) evaluates the insulin response challenge. It is useful

in evaluating pregnancy-induced diabetes and involves drawing a fasting blood

specimen, followed by patient ingestion of a 75-g oral dose of glucose in liquid
within a 5-minute period. Blood samples are then taken at 30-, 60-, 120-, and
180-minute intervals and tested for glucose. Urine is tested as well.
(1) Nondiabetics have negative urine tests and show highest glucose levels at 30
to 60 minutes, with low and normal levels following.
(2) Severe diabetics reach peak glucose levels after 30 to 60 minutes, and the
levels remain elevated.
b. A 2-hour postprandial blood glucose test evaluates diabetes. A fasting blood
specimen and a specimen taken 2 hours after breakfast are taken. Normal patients
have no increase in serum glucose after 2 hours.

What are Carbohydrates?

Main energy source; Provides body

with basic fuel

What is the universal energy

ATP (Adenosine Triphosphate)
source for biological reactions?
What two pathways is the
primary energy source for the
synthesis of ATP?

By Glucose Oxidation by the

Glycolytic and Tricarboxylic Acid
Pathwaysa

What 3 Elements makes up a

Carbohydrate molecule?

Carbon, Hydrogen and Oxygen

What groups does all

Carbohydrates contain?

Carbonyl (C=O), and Hydroxyl (OH) groups

What are the classification of

Carbohydrates based on?

Size of base carbon chain; Location

of C=O; Stereochemistry of hte
compound; Number of sugar units

How many Carbons is in

6 carbons; Fructose, Galactose, and
Hexose, and what are the most
Glucose
common examples?
What are two foers of
Carbohydrates?

Aldose- Aldehyde is its functional

group; Ketose- ketone as its
functional group

What is Stereochemistry?

Study of the spatial arrangements

of molecules

What are sterioisomers?

Compoundsthat have the same

order and types of bonds, but
different spatial arrangements and
different properties.

Can Stereoisomers be
overlapped?

No, they are mirror images but

can't be overlapped.

What is Optical Activity?

Ability to rotate plane polarized

light (dextrorotatory- rotate to
right; Levorotatory- rotate to left)

What are Monosaccharides

"simple sugars"?

contain 3-6 carbins; sweet in taste;

most common (glucose, fructose,
galactose)

What are the only carbs that

can be absorbed into the
bloodstream through the
intestines?

Monosaccharides

Which sugar is known as the

"blood" sugar?

Glucose

What is the sugar in milk and

yogurt?

Galactose

What is the sugar found in

honey?

Fructose

What are Oligosaccharides?

contain 2- 10 monosaccharides;
Most are reducing sugars (not
sucrose)

What type of Carbs are formed

on the interaction of groups
Disaccharides
between 2 monosacccharides
with the production of water?
What are the most common
"double" sugars?

Sucrose, Lactose, and Maltose

What 2 monosaccharides make

up Sucrose (common table
glucose and Fructose
sugar)?
What 2 monosaccharides make
up Lactose (major sugar in
Glucose and galactose
milk)?
What 2 monosaccharides make
up Maltose (product of starch
Glucose and glucose
digestion)?
What is the most common
sugar in plants?

Table sugar

What enzyme is required to

hydrolyze lactose?

Lactase

What is Lactose Intolerance?

Lack or insufficient amount of the

enzyme Lactase

What are some useses of

Maltose?

Ingredient in infant formula;

Production of beer; Flavoring-fresh
baked aroma

What are long chains of more

than 10 monosaccharides
(polymers of the simple
sugars)

Polysaccharides

Which type of cabohydrate

digest at a much slower rate?

polysaccharides

Name the most common

examples of Poly saccharides

Starch & Glycogen

What uses starch to store

glucose

Plants

What uses Glycogen to store

glucose

Animals

What is stored in the liver and

muscles tissue as an "instant"
source of energy?

Glycogen

What is Oxidation?

Loss of an electron (L E O)

What is Reduction?

Gaining of an electron (G E R)

Reducing substances must

contain what type of groups?

Aldehyde of Ketone group

What is Metabolism?

The sum of all the chemical

reactions that occur in the cell

What is Anabolism?

Synthesis of all compounds needed

by the cell

What i sthe breakdown of all

molecules to obtain energy?

Catabolism

What is an enzyme?

a protein molecule that functions

as an organic catalyst to speed up
a chemical reaction, without itself
being affected by the reaction

Which enzyme is responsible

for the digetstion of nonabsorbable polymers?

Amylase

Which enzyme is responsible

for the hydrolysis of food into
smaller subunits?

Amylase

Which enzyme Hydrolyzes

Lactose?

Lactase

What is the only carbohydrate

to be directly used for energy
or stored as glycogen?

Glucose

Within the cell What is glucose Glucose-6-Phosphate, a major

rapidly converted to?
intermediate in glucoe metabolism
What does all basic cell
functions and the whole body
in general need?

ATP ( Adenosine Triphosphate )

What is Hexokinase?

A tissue-specific isoenzyme used to

catalyze the conversion of Glucose
to Glucose-6-Phosphate.

What is Glycolysis?

Metabolism of Glucose to either

pyruvate of lactate for the
production of energy

In Aerobic Glycolysis, what is

the dominant product?

Pyruvate

In Anaerobic Glycolysis,
oxygen is depleted. What is
the dominant product?

Lactate

How many ATP , and NADH

molecules are created by the
Glycolytic Pathway?

2 ATP, and 2 Pyruvate

What is the Prepatory Phase?

The phase where O2 prepares

pyruvate to go into the cell for the
Kreb Cycle

How many ATP are created by

the Tricarboxylic Acid (Kreb

2 ATP molecules

Cycle; Kreb Cycle)?

How many ATP molecules are
created by the Electron
Transport Chain?

32 34

How many total ATP molecules

are created by Aerobic
36 38
Glycolysis ( Embden-Meyerhof
pathway)?
In the absence of oxygen, what
can pyruvic acid be converted Lactic Acid
to?
What are the side effects of
Lactic acid bulid up?

Muscle fatigue, pain, cramps, and

soreness

when is Lactic acid converted

back to oxygen?

Most arediffused into the

bloodstream then to the liver
where it is converted back to
pyruvic acid when oxygen becomes
available

What is a detour of Glucose-6Phosphate from the glycolytic

pathway to become 6phosphogluconic acid?

Hexose Monophosphate shunt

9HMP)

What is important to RBC's

which lack mitochondria?

NADPH

What is glycogenesis?

Conversion of glucose to glycogen

for storage

What is the breakdown of

glycogen to glucose for use as Glycogenolysis
energy?
Glycogenolysis is mediated by
what wnzyme?

glycogen phosphorylase

What are the major depots of

glycogen?

The liver and skeletal muscles

What is Gluconeogeogenesis?

If neither glucose nor glycogen are

available to meet the body's

energy demands, the liver will

synthesize glucose from proteins or
lipids (non-carbohydrate sources)
What is the only hormone that
decreases the blood glucose
Insulin
levels?
What is the primary hormone
responsible for the entry of
glucose into the cell?

Insulin

Where is Insulin produced?

By the Beta cels othe Islet of

Langerhans in the pancreas

What is insulin referred to?

"Hypoglycemic Agent"

What is Glucagon?

The primary hormone responsible

for increasing glucose levels ;
secreted by alpha cellls of the Islet
of Langerhans in the pancreas;
"Hyperglycemic Agent"

Which hormone that increases

glucose is produced by the
Epinephrine
adrenal medulla?
What is released from the
adrenal cortex on stimulation
by ACTH?

Glucocorticoids; Primarily cortisol

What inhibits glucose uptake

by the tissues and is secreted
by the Anterior Pituitary?

Somatotropin

What increases plasma

glucose by converting liver
glycogen to glucose?

ACTH

What is secreted by teh thyroid

gland on stimulation of the
Thyroxine (T4)
Thyroid Stimulating Hormone
(TSH)?
Where is somatostatin
secreted from?

A broad range of tissues including

pancreas, intestinal tract, and

regions of the CNS outside the

hypothalamus.
What is Hyperglycemia?

An increase in plasma glucose

levels, caused by an imbalalance of
hormones

What is a group of metabolic

diseases characterized by
hyperglycemia resulting from
defect in insulin secretion,
insulin action or both?

Diabetes Mellitus

What is Type I Diabetes?

An absolute deficiency of insulin

secretion due to beta cell
destruction

What are some signs and

symptoms of Type I Diabetes?

Polydipsia ( excessive thirst),

polyphagia ( increased food
intake), polyuria (excessive urine
production), rapid weight loss,
hyperventilation, Mental confusion,
Possible loss of consciousness

What is Kidney disease that

leads to kidney failure?

Nephropathy

What is neuropathy?

Peripheral nerve disorder

What is Retinopathy?

Occurs when diabetes damages the

tiny blood vessels in the retina

What is Type 2 Diabetes?

A result of individual's resistance to

insulin, with an insulin secretory
defect

What is the most common

form of Diabetes?

Type 2 Diabetes

What is Gestational Diabetes?

Elevated blood sugar due to certain

hormones that occur only during
pregnancy.