Carbohydrate metabolism
Gluconeogenesis and glycolysis
PENTOSE PHOSPHATE PATHWAY (HEXOSE MONOPHOSPHATE SHUNT) Oxidative phase
Isomerase Ribose-5 phospate Nucleotides Nucleic Acids Epimerase Ribulose-5 phospate Xylulose-5 phospate Nonoxidative phase
Non-oxidative phase Glycolysis
Glycolysis
The overall equation: 6 G-6 -P + 12 NADP+ + 7 H 2 O 5 G-6 -P + 12 NADPH + 6 CO 2 + 12 H +
Violation of pentose phosphate pathway
Ethanol metabolism
Ethanol metabolism in the human body
Ethanol metabolism
Ethanol metabolism Acetate is used as a source of energy
Glycogen Metabolism Glycogen in the cell
Glycogen structure
Glycogenesis (glycogen synthesis)
Glycogen syntase
glycogen branching enzyme
Regulation of glycogen synthase activity Insulin Glycogen synthase inactive P Phosphatase Protein kinase Glucagon Glycogen synthase active OH
Degradation of glycogen Glycogen phosphorylase
glycogen phosphorylase G-1 -P
Action of debranching enzyme
Glycogen metabolism regulation
Glucogen storage diseases
Glycogenosis Gierke's disease, glycogenosis type I Glucose-6 -phosphatase deficiency Hepatonephromegaly, hypoglycemia, lactic acidosis, growth failure
Pompe’s disease, glycogenosis type II -1, 4 glucosidase deficiency Hepatomegaly, enlarged heart, muscle weakness, heart and respiratory failure. Death by age ~2 years 35
Forbes-Cori's disease, glycogenosis type III Amilo-(1 -6)-glycosidase and (or) glycogen branching enzyme deficiency Hepatomegaly, hypoglycemia, myopathy, retarded growth. 36
Andersen's disease, glycogenosis type IV glycogen branching enzyme deficiency Accumulation of abnormal polysaccharides, hepatosplenomegaly, cirrosis, abnormalities of the heart and nervous system, faltering weight. Death at age ~5 years 37
Mc. Ardle's disease, glycogenosis type V Muscle phosphorylase deficiency Muscle weakness, exercise-induced cramps 38
Carbohydrate metabolism regulation
Main pathways of carbohydrate metabolism Insulin Glucagon
Insulin • Stimulate glucose transport into cells • Induses synthesis of glucokinase, phosphofructokinase, pyruvate kinase activates glycolysis • Activates protein phosphatase * activates pyruvate kinase (activates glycolysis); * increases kinase activity of BIF (activates glycolysis) *activates glycogen synthase and deactivates glycogen phosporylase (activates glycogen synthesis)
Glucagon • Activates protein kinase * increases phosphatase activity of BIF (activates gluconeogenesis) *activates glycogen phosporylase and deactivates glycogen synthase (activates glycogen synthesis)
Changes in the concentrations of glucose, insulin, glucagon after meals.
Baudouin Coefficient (hyperglycemic coefficient)
Glycemic index graph in norm (1) and diabetes (2)
Diabetes Feature Type 1 diabetes Type 2 diabetes Onset Sudden Gradual Age at onset Mostly in children Mostly in adults Body habitus Thin or normal Often obese Ketoacidosis Common Rare Autoantibodies Usually present Absent Endogenous insulin Low or absent Normal, decreased or increased Prevalence ~10% ~90%
Main manifestations of diabetes • Polyuria and polydipsia • Hyperglycemia • Decreased synthesis and deposition of glycogen and fat • Hyperlipoproteinemia • Ketonemia • Azotemia and azoturia
Complications of diabetes mellitus State Urine glucose Urine acetone Plasma glucose Bicarbonate Acetone Hypoglycemia 0 0 or + High Normal 0 Diabetic ketoacidosis (DKA) ++++ High Normal or slightly low 0 Hyperglycemic hyperosmolar syndrome (HHS) ++++ 0
Protein glycosylation
Diabetes long-term complications
Insuline preparations
Glucometer
Insulin pump
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