B.

sc Nursing 2nd Sem Applied Biochemistry Bhushan Science

[Link] Nursing 2nd Sem Applied Biochemistry Bhushan Science

UNIT 1

CARBOHYDRATES

• Carbohydrates are organic compounds made up of carbon, hydrogen, and oxygen atoms,
usually with a hydrogen to oxygen atom ratio of 2:1.
• They are one of the main types of nutrients and the most important source of energy for many
organisms.

1. SIMPLE CARBOHYDRATES:
• Simple carbohydrates are organic compounds composed of one or two sugar molecules,
known as monosaccharides and disaccharides.
• These carbohydrates are relatively small in size and are characterized by their quick
digestion and absorption in the body, leading to rapid increases in blood sugar levels.

There are two types of simple carbohydrates:

a) Monosaccharides: These are the simplest form of carbohydrates, consisting of single
sugar molecules. Examples include glucose, fructose, and galactose.
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Physical Properties:
• Solubility: Highly soluble in water due to hydrophilic nature.
• Taste: Generally sweet.
• State: Solid at room temperature.
• Crystalline Structure: Most are crystalline in nature.

Chemical Properties:
• Reducing Sugar: They act as reducing agents (e.g., glucose).
• Isomerism: Exhibit structural isomerism (e.g., glucose and fructose).
• Ring Structure Formation: Exist in cyclic structures in aqueous solutions.

b) Disaccharides: These consist of two monosaccharide molecules linked together. Common

disaccharides include sucrose (table sugar), lactose (found in milk), and maltose.

Physical Properties:
• Solubility: Generally soluble in water.
• Taste: Typically, sweet, varying in intensity.
• Physical Form: Solid at room temperature, often crystalline.
• Optical Activity: Rotate plane-polarized light; specific rotation depends on structure.

Chemical Properties:
• Glycosidic Bond Formation: Consist of two monosaccharides joined by a glycosidic
bond.
• Hydrolysis: Can be broken down into their monosaccharide units by hydrolysis.
• Reducing and Non-Reducing Types: Some act as reducing sugars (e.g., maltose), while
others like sucrose do not.
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• Reactivity: Less reactive than monosaccharides due to the involvement of their carbonyl
group in glycosidic bond.
• Mutarotation: Exhibit mutarotation upon hydrolysis.
• Chemical Stability: More stable than monosaccharides but can participate in chemical
reactions like Maillard browning.

2. COMPLEX CARBOHYDRATES:
• Complex carbohydrates are organic compounds composed of multiple sugar molecules
(monosaccharides) linked together in long chains.
• These chains can vary in length and complexity, and they are also known as polysaccharides.
• This gradual release of energy makes complex carbohydrates an important source of sustained
energy for the body.

Polysaccharides: These are complex carbohydrates made up of long chains of monosaccharide

units. They include starches, glycogen (the storage form of glucose in animals), and dietary fibers
like cellulose.

Physical Properties:
• Solubility: Generally insoluble or less soluble in water.
• Taste: Typically, not sweet.
• State: Solid, often amorphous or fibrous.
• Molecular Weight: High molecular weight due to long polymer chains.

Chemical Properties:
• Glycosidic Bonds: Long chains of monosaccharides connected by glycosidic bonds.
• Structural Diversity: Vary in length, branching, and types of monosaccharides.
• Hydrolysis: Can be hydrolyzed to simpler sugars, often requiring specific enzymes.
• Non-Reducing Nature: Usually do not have free aldehyde or ketone groups.
• Biological Functions: Serve as energy stores (e.g., starch, glycogen) and structural
components (e.g., cellulose, chitin).
• Chemical Reactions: Less reactive than mono- and disaccharides; involved in
biochemical processes like energy storage and structural support.

FUNCTIONS OF CARBOHYDRATES:
Carbohydrates play several crucial roles, functioning as key sources of energy, structural
components, and in cell signaling.
1. Energy Source:
• Carbohydrates are the body's primary and preferred source of energy.
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• They are broken down into glucose, which is used by cells for energy through a process
called cellular respiration.
• Glucose can be used immediately or stored as glycogen in the liver and muscles for later
use.
2. Structural Components:
• Certain carbohydrates are integral structural components of cells and tissues.
• For example, cellulose, a polysaccharide found in plant cell walls, provides structural
support.
• In humans and animals, glycosaminoglycans (such as chondroitin and hyaluronic acid) are
important for the structure and function of connective tissues and cartilage.
3. Cell Signaling and Recognition:
• Carbohydrates are involved in cell signaling and cellular recognition processes.
• Glycoproteins and glycolipids, which are carbohydrates attached to proteins and lipids, are
present on the cell surface and play a role in cell-to-cell communication and immune
responses.
• These structures are critical in processes like immune cell recognition and the targeting of
cells by viruses and bacteria.
4. Source of Dietary Fiber:
• Certain carbohydrates, like fiber, are not digestible by human enzymes but play a crucial
role in maintaining gut health.
• Fiber aids in digestion, helps regulate blood sugar levels, and supports a healthy gut
microbiome.
5. Energy Storage:
• In plants, carbohydrates are stored as starch, which can be broken down into glucose for
energy during periods of low photosynthesis.
• In animals, as mentioned earlier, excess glucose is stored as glycogen.
6. Precursors for Other Biochemical Substances:
• Carbohydrates can be converted into other essential substances, such as amino acids and
fatty acids.
• They also contribute to the synthesis of nucleotides, which are the building blocks of DNA
and RNA.

DIGESTION, ABSORPTION AND METABOLISM OF CARBOHYDRATES AND

RELATED DISORDERS

DIGESTION OF CARBOHYDRATES
The digestion of carbohydrates is a process that breaks down complex carbohydrate molecules into
simpler sugars, primarily glucose, which the body can use for energy.

Here's an overview of how this process occurs:

1. Digestion in mouth:
Carbohydrate digestion in the mouth involves the action of an enzyme called salivary amylase,
which is secreted by the salivary glands.
• Salivary Amylase: When you chew food, your salivary glands release saliva containing
an enzyme called salivary amylase.
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• Starch Breakdown: Salivary amylase starts breaking down complex carbohydrates, like
starches, into simpler sugars.
• Hydrolysis: Salivary amylase breaks the bonds holding glucose molecules in starch,
making them easier to digest.
• Maltose Production: This process produces maltose, a simpler sugar made of two glucose
molecules.
Salivary α-amylase
Starch, glycogen and dextrins Glucose, maltose, maltotriose
2. Digestion in stomach:
Carbohydrate digestion in the stomach is limited and mainly involves the continuation of
mechanical digestion.
• Acidic Environment: The stomach contains strong acid (HCl) for digesting proteins, not
carbohydrates.
• Protein Digestion: Protease enzymes, like pepsin, break down proteins in the stomach's
acidic environment.
• Limited Carbohydrate Digestion: Carbohydrate digestion, especially starch, slows down
in the stomach due to the acidity, as the focus is on protein digestion.
3. Digestion in small intestine:
Carbohydrate digestion in the small intestine is where the majority of carbohydrate breakdown and
absorption takes place.
• Pancreatic Amylase: In the duodenum, the pancreas releases pancreatic amylase, which
continues breaking down complex carbohydrates like starches.
• Oligosaccharides and Maltose: Pancreatic amylase hydrolyzes starches into maltose (a
disaccharide) and oligosaccharides (short sugar chains).
• Brush Border Enzymes: Specialized enzymes on the small intestine's surface further
break down disaccharides and oligosaccharides into monosaccharides for absorption.

Pancreatic amylase
Starch Maltose, maltotriose, α-limit dextrins and glucose

• These enzymes include maltase, sucrase, and lactase.

a. MALTASE: Breaks maltose into two glucose molecules.

Maltase
Maltose Glucose + Glucose

b. SUCRASE: Breaks sucrose (table sugar) into glucose and fructose.

Sucrase
Sucrose Glucose + Fructose

c. LACTASE: Breaks lactose (milk sugar) into glucose and galactose.

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Lactase
Lactose Glucose + galactose

d. ISOMALTASE: Acts on α-1,6-glycosidic bonds in isomaltose

Isomaltase
Isomaltose Glucose

e. Α-LIMIT DEXTRINS: producing glucose.

Dextrinase
α-Limit dextrins Glucose

ABSORPTION OF CARBOHYDRATES
• Carbohydrates are taken up from the jejunum in the small intestine as simple sugars like
glucose, fructose, and mannose.
• They enter the blood through two main ways: active transport, which moves sugars
against their concentration, and passive transport, which moves them along their
concentration gradient.
• Fructose absorbs more slowly and usually moves passively using a transporter protein
called GLUT5.
• Glucose and galactose can also use GLUT5 when their levels are high enough. If not,
glucose uses an active transporter called SGLT1, which works with sodium to pull
glucose into the cell.
• This needs energy, which is gotten from ATP, a molecule in cells that stores energy. Once
absorbed, these sugars provide energy or can be stored in the body.
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METABOLISM OF CARBOHYDRATES
• Carbohydrates, primarily glucose, are the main energy source for cells. Glucose is key in
metabolism across plants, animals, and microorganisms.
• Starch and glycogen act as storage for glucose in plants and animals, respectively.
• When needed, glucose is released from these stores to generate ATP, the energy currency of
the cell, through aerobic or anaerobic pathways.

1. GLYCOLYSIS:
• Glycolysis is a fundamental biochemical pathway that occurs in the cytoplasm of cells, and it
represents the initial stage of carbohydrate metabolism.
• It involves the breakdown of one molecule of glucose (a six-carbon sugar) into two molecules
of pyruvate (each a three-carbon compound) through a series of enzymatic reactions.
• Glycolysis is an anaerobic process, meaning it can occur without the presence of oxygen.

Steps in glycolysis:
a. Glucose Activation:
• The process begins with the phosphorylation of glucose, which involves the addition of a
phosphate group (from ATP) to glucose.
• This converts glucose into glucose-6-phosphate, making it less likely to leave the cell.
b. Isomerization:
• Glucose-6-phosphate is then rearranged and isomerized to become fructose-6-phosphate.
c. Second Phosphorylation:
• Another phosphate group is added to fructose-6-phosphate, resulting in fructose-1,6-
bisphosphate. This step requires ATP as well.
d. Cleavage:
• Fructose-1,6-bisphosphate is cleaved into two three-carbon molecules: dihydroxyacetone
phosphate (DHAP) and glyceraldehyde-3-phosphate (G3P).
• These two molecules are isomers, and G3P is the one further processed in glycolysis.
e. Energy Harvesting Steps:
• G3P undergoes a series of reactions where it is oxidized, and electrons are transferred to
NAD+ to form NADH.
• Phosphate groups are added to G3P, ultimately resulting in the formation of 1,3-
bisphosphoglycerate (1,3-BPG).
• ATP is generated as 1,3-BPG transfers its phosphate group to ADP, forming ATP.
f. Production of Pyruvate:
• The remaining steps involve the conversion of 3-phosphoglycerate (3-PG) into 2-
phosphoglycerate (2-PG) and then into phosphoenolpyruvate (PEP).
• In the final step, PEP donates its phosphate group to ADP, producing another ATP molecule.
g. Pyruvate Formation:
• The end result of glycolysis is the production of two molecules of pyruvate from two
molecules of G3P. This step also generates NADH.
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2. PYRUVATE OXIDATION:
• Pyruvate oxidation is a crucial step in cellular respiration, a biochemistry process that takes
place in the mitochondria of eukaryotic cells.
• This step bridges the gap between glycolysis (which occurs in the cytoplasm) and the citric
acid cycle (Krebs cycle) within the mitochondria.
• Pyruvate oxidation involves the conversion of pyruvate, a three-carbon compound produced
during glycolysis, into acetyl-CoA, a two-carbon compound that can enter the citric acid cycle
for further energy production.

Steps in pyruvate oxidation:

a. Transport into Mitochondria: Pyruvate, which is produced during glycolysis in the
cytoplasm, must first be transported into the mitochondria to enter the citric acid cycle.
Pyruvate is actively transported across the mitochondrial membrane.
b. Decarboxylation: Inside the mitochondria, each pyruvate molecule undergoes
decarboxylation, where a carbon atom is removed from pyruvate in the form of carbon dioxide
(CO2). This reaction is catalyzed by the enzyme pyruvate dehydrogenase complex (PDC).
c. Acetyl-CoA Formation: After decarboxylation, the remaining two-carbon molecule combines
with coenzyme A (CoA) to form acetyl-CoA. This molecule is a key intermediate in cellular
respiration and serves as the entry point for pyruvate into the citric acid cycle.

3. CITRIC ACID CYCLE:

• The citric acid cycle, also known as the Krebs cycle or TCA cycle (tricarboxylic acid cycle),
is a central metabolic pathway that takes place in the mitochondria of eukaryotic cells.
• It plays a crucial role in the oxidation of acetyl-CoA, derived from various fuel sources such
as glucose, fatty acids, and amino acids.
• The citric acid cycle is a series of enzyme-catalyzed reactions that ultimately leads to the
production of high-energy molecules and carbon dioxide.

Steps in the citric acid cycle:

a. Acetyl-CoA Entry
• Acetyl-CoA, a two-carbon molecule, combines with a four-carbon compound called
oxaloacetate to form citrate (a six-carbon compound).
• This step is catalyzed by the enzyme citrate synthase.
b. Citrate Isomerization
• Citrate is isomerized to isocitrate.
• The enzyme aconitase is responsible for this conversion.
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c. Oxidative Decarboxylation of Isocitrate

• Isocitrate is oxidatively decarboxylated to form alpha-ketoglutarate.
• During this step, one molecule of NADH and one molecule of carbon dioxide (CO2) are
produced.
• The enzyme isocitrate dehydrogenase facilitates this reaction.
d. Decarboxylation of Alpha-Ketoglutarate
• Alpha-ketoglutarate undergoes another oxidative decarboxylation reaction, producing one
molecule of NADH and one molecule of CO2.
• The enzyme alpha-ketoglutarate dehydrogenase catalyzes this reaction.
e. Substrate-Level Phosphorylation
• Succinyl-CoA is formed from alpha-ketoglutarate.
• One molecule of guanosine triphosphate (GTP) is generated via substrate-level
phosphorylation, and GTP can subsequently be converted to ATP.
• The enzyme succinyl-CoA synthetase catalyzes this reaction.
f. Oxidation of Succinate
• Succinate is oxidized to fumarate, leading to the production of two molecules of FADH2.
• The enzyme succinate dehydrogenase is unique because it is embedded in the inner
mitochondrial membrane and is also part of the electron transport chain.
g. Hydration of Fumarate
• Fumarate is hydrated to form malate.
• The enzyme fumarase (also known as fumarate hydratase) facilitates this reaction.
h. Regeneration of Oxaloacetate
• Malate is oxidized to regenerate oxaloacetate.
• During this step, one molecule of NADH is produced.
• The enzyme malate dehydrogenase catalyzes this reaction.
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4. GLUCONEOGENESIS:
• Gluconeogenesis is a vital biochemical pathway that occurs primarily in the liver and, to a
lesser extent, in the kidneys.
• It is the process by which the body synthesizes new glucose molecules from non-carbohydrate
precursors, such as amino acids, glycerol, and lactate.
• Gluconeogenesis is crucial for maintaining blood glucose levels within a narrow range,
especially when dietary sources of glucose are limited.

Steps and concepts involved in gluconeogenesis:

a. Conversion of Pyruvate to Phosphoenolpyruvate (PEP):
• Pyruvate, a three-carbon compound, is converted into oxaloacetate (a four-carbon
compound) by the enzyme pyruvate carboxylase.
• This reaction occurs in the mitochondria.
• Oxaloacetate is then transported to the cytoplasm and converted into phosphoenolpyruvate
(PEP) by the enzyme PEP carboxykinase.
• This step consumes energy in the form of GTP.
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b. Conversion of Fructose-1,6-Bisphosphate to Fructose-6-Phosphate:

• The enzyme fructose-1,6-bisphosphatase catalyzes the hydrolysis of fructose-1,6-
bisphosphate to form fructose-6-phosphate.
• This step bypasses the irreversible glycolytic reaction catalyzed by phosphofructokinase-
1.
c. Conversion of Glucose-6-Phosphate to Glucose:
• The enzyme glucose-6-phosphatase is found in the endoplasmic reticulum of liver cells
and catalyzes the dephosphorylation of glucose-6-phosphate to produce glucose.
• Glucose can then be released into the bloodstream to maintain blood sugar levels.

5. GLYCOGENESIS:
• Glycogenesis is a biochemical process that involves the synthesis and storage of glycogen, a
branched polymer of glucose molecules, primarily in the liver and muscle cells.
• It is the reverse of glycogenolysis, which is the breakdown of glycogen into glucose for energy.
Glycogenesis occurs when blood glucose levels are high, and the excess glucose is converted
into glycogen for later use.
Steps and concepts involved in glycogenesis:
a. Formation of Glucose-1-Phosphate (G1P):
• If glucose is not already in the form of G6P, it is first converted to G6P by the enzyme
hexokinase or glucokinase.
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• G6P is then converted to G1P by the enzyme phosphoglucomutase.

b. Activation of Glucose:
• G1P is activated by the addition of a uridine diphosphate (UDP) molecule to form UDP-
glucose.
• This reaction is catalyzed by the enzyme UDP-glucose pyrophosphorylase.
c. Initiation of Glycogen Chain:
• A small primer glycogen molecule (typically containing 8 to 12 glucose residues) is
formed. This primer acts as the starting point for glycogen synthesis.
• The primer glycogen molecule is attached to a protein called glycogenin.
d. Glycogen Synthesis:
• UDP-glucose is added to the primer glycogen molecule one glucose molecule at a time by
the enzyme glycogen synthase.
• The glucose molecules are linked together by alpha-1,4-glycosidic bonds, forming a linear
chain.
e. Branching of Glycogen:
• To create the characteristic branched structure of glycogen, a branching enzyme (glycogen
branching enzyme or amylo-(1,4→1,6)-transglycosylase) cleaves a portion of the linear
chain and transfers it to another location, creating alpha-1,6-glycosidic bonds.
• This branching allows for efficient storage and rapid release of glucose when needed.

6. GLYCOGENOLYSIS:
• Glycogenolysis is a fundamental biochemical process that involves the breakdown of
glycogen, a branched polymer of glucose molecules, into individual glucose molecules.
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• This process occurs primarily in the liver and muscle cells and is crucial for providing a quick
and accessible source of glucose when the body needs energy, such as during physical activity
or periods of low blood sugar.

Steps and concepts involved in glycogenolysis:

a. Activation of Glycogen Phosphorylase:
• The process begins when a need for glucose arises, such as during exercise or periods of
low blood sugar.
• An enzyme called glycogen phosphorylase is activated by hormonal signals, including
glucagon and epinephrine (adrenaline).
• Glycogen phosphorylase catalyzes the removal of glucose molecules from the non-
reducing ends of glycogen chains, releasing glucose-1-phosphate (G1P).
b. Conversion of G1P to Glucose-6-Phosphate (G6P):
• The G1P released during glycogenolysis is converted into glucose-6-phosphate (G6P) by
the enzyme phosphoglucomutase.
• G6P can then be further metabolized to produce glucose for energy.
c. Production of Free Glucose:
• G6P is converted into free glucose by the enzyme glucose-6-phosphatase in the liver, which
allows the release of glucose into the bloodstream.
• In muscle cells, G6P is used primarily for energy within the cell and does not contribute to
blood glucose levels.

METABOLISM RELATED DISODERS OF CARBOHYDRTES

Carbohydrate-related disorders are medical conditions that involve abnormalities in the
metabolism, utilization, or regulation of carbohydrates in the body.
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These disorders can result from genetic mutations, hormonal imbalances, or dietary factors.

Here are some common carbohydrate-related disorders:

1. Diabetes Mellitus:
• Diabetes mellitus is a group of metabolic disorders characterized by elevated blood glucose
levels (hyperglycemia) due to impaired insulin production (Type 1 diabetes), reduced
insulin sensitivity (Type 2 diabetes), or a combination of both.
• It can lead to long-term complications affecting various organ systems, including the eyes,
kidneys, nerves, and blood vessels.
2. Hypoglycemia:
• Hypoglycemia refers to abnormally low blood glucose levels. It can result from excessive
insulin production, certain medications, alcohol consumption, or rare enzyme deficiencies.
• Symptoms of hypoglycemia can include dizziness, confusion, sweating, and, in severe
cases, loss of consciousness.
3. Glycogen Storage Diseases (GSDs):
• GSDs are a group of rare genetic disorders characterized by defects in enzymes involved
in glycogen metabolism.
• Depending on the specific enzyme deficiency, GSDs can lead to the accumulation of
abnormal glycogen molecules in tissues or the inability to break down glycogen into
glucose.
• Each type of GSD is associated with specific symptoms and complications, such as muscle
weakness, hepatomegaly (enlarged liver), and hypoglycemia.
4. Galactosemia:
• Galactosemia is a genetic disorder that affects the metabolism of galactose, a sugar found
in milk and dairy products.
• Individuals with galactosemia lack one of the enzymes necessary to convert galactose into
glucose, leading to the buildup of galactose and its toxic byproducts.
• Symptoms can include liver damage, cataracts, and developmental issues if left untreated.
5. Fructose Intolerance:
• Fructose intolerance is a hereditary disorder caused by a deficiency of the enzyme aldolase
B, which is necessary for the breakdown of fructose.
• In individuals with fructose intolerance, the ingestion of fructose or sucrose (a combination
of fructose and glucose) can lead to symptoms such as abdominal pain, bloating, and
diarrhea.
6. Lactose Intolerance:
• Lactose intolerance is a common condition characterized by the inability to digest lactose,
a sugar found in milk and dairy products, due to a deficiency of the enzyme lactase.
• Symptoms typically include gas, bloating, diarrhea, and abdominal discomfort after
consuming lactose-containing foods or beverages.
7. Celiac Disease:
• Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, a protein
found in wheat, barley, and rye.
• In individuals with celiac disease, the immune system attacks the lining of the small
intestine, leading to malabsorption of nutrients, including carbohydrates, and various
gastrointestinal and systemic symptoms.
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REGULATION OF BLOOD GLUCOSE

The regulation of blood glucose levels is a crucial process in the body, involving several hormones
and organs.
1. Key Hormones:
• Insulin: Produced by the pancreas, insulin lowers blood glucose levels by facilitating the
entry of glucose into cells and promoting the storage of glucose as glycogen in the liver
and muscles.
• Glucagon: Also produced by the pancreas, glucagon raises blood glucose levels by
promoting the breakdown of glycogen to glucose in the liver.
2. Processes Involved:
• Glycogenesis: When blood glucose levels are high, insulin stimulates the liver and muscle
cells to convert glucose into glycogen for storage (glycogenesis).
• Glycogenolysis: When blood glucose levels drop, glucagon stimulates the liver to convert
stored glycogen back into glucose (glycogenolysis).
• Gluconeogenesis: In prolonged low glucose conditions, like fasting, the liver produces
glucose from non-carbohydrate sources.
3. Role of Other Hormones:
• Cortisol, Epinephrine (Adrenaline), and Growth Hormone: These hormones also
influence blood glucose levels, generally working to increase glucose availability during
stress or increased energy demands.
4. Feedback Mechanism:
• The regulation of blood glucose levels is a feedback mechanism. High blood glucose
triggers insulin release to lower it, while low blood glucose triggers glucagon release to
raise it.
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DIABETES MELLITUS – TYPE 1 & TYPE 2, SYMPTOMS, COMPLICATIONS &

MANAGEMENT IN BRIEF

Diabetes Mellitus is a group of metabolic diseases characterized by high blood sugar levels over a
prolonged period.
This high blood sugar occurs due to issues with insulin production or action:
• Insulin Production: In some cases, the pancreas doesn't produce enough insulin.
• Insulin Action: In other cases, the body's cells do not respond properly to insulin.

TYPE 1 DIABETES:
• Description: The body's immune system attacks and destroys insulin-producing cells in the
pancreas.
• Symptoms: Increased thirst, frequent urination, hunger, weight loss, fatigue, blurred vision.
• Complications: Can include cardiovascular disease, nerve damage, kidney damage, eye
damage, foot problems, skin conditions, and pregnancy complications.
• Management: Requires regular insulin injections or an insulin pump, along with blood sugar
monitoring, healthy eating, and regular exercise.

TYPE 2 DIABETES:
• Description: Characterized by insulin resistance; the body's cells don't use insulin effectively,
and over time, the pancreas can't make enough insulin.
• Symptoms: Similar to Type 1, but may also include areas of darkened skin. Some people may
not show symptoms initially.
• Complications: Similar to Type 1, including heart and blood vessel disease, neuropathy,
nephropathy, retinopathy, hearing impairment, and Alzheimer's disease.
• Management: Often includes lifestyle changes like weight loss, healthy eating, and regular
exercise. Medications and insulin therapy may also be required.
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INVESTIGATION OF DIABETES MELLITUS

A. OGTT
The Oral Glucose Tolerance Test (OGTT) is a key investigation used to diagnose diabetes mellitus.
1. Indications for OGTT:
• Suspicion of Diabetes: When someone shows symptoms of diabetes or has borderline high
fasting glucose levels.
• During Pregnancy: To screen for gestational diabetes, usually around 24-28 weeks.
• In Prediabetes: To determine how well the body's insulin is working.
2. Procedure of OGTT:
• Fasting: The patient fasts overnight (at least 8 hours, but not more than 16 hours).
• Initial Blood Sample: A fasting blood glucose level is taken.
• Glucose Intake: The patient drinks a sweet solution containing a specific amount of
glucose (usually 75 grams).
• Further Blood Samples: Blood glucose levels are then measured at various intervals,
typically after 1 hour and 2 hours.
3. Interpretation of Results:
• Normal: Fasting glucose less than 100 mg/dL, and 2-hour glucose less than 140 mg/dL.
• Prediabetes (Impaired Glucose Tolerance): Fasting glucose 100-125 mg/dL, or 2-hour
glucose 140-199 mg/dL.
• Diabetes: Fasting glucose 126 mg/dL or higher, or 2-hour glucose 200 mg/dL or higher.
4. Types of GTT Curve:
• Normal Curve: A rise in blood glucose after drinking the solution, followed by a decrease
as insulin works to normalize levels.
• Diabetic Curve: Higher than normal rise in glucose levels and slower return to normal,
indicating insulin resistance or inadequate insulin production.
• Impaired Glucose Tolerance: Blood glucose levels between normal and diabetic ranges,
indicating prediabetes.

B. MINI GTT, EXTENDED GTT, GCT, IV GTT

Glucose Tolerance Tests (GTTs) are used to assess how well the body processes glucose and are
essential in diagnosing and managing diabetes.
Here's a brief overview of various types of GTTs:
1. Mini GTT (Glucose Tolerance Test)
• Procedure: Similar to the standard OGTT but with a smaller glucose load (usually 50
grams).
• Use: Often used as a preliminary screening tool, especially in pregnancy to check for
gestational diabetes.
2. Extended GTT
• Procedure: Similar to the standard OGTT but extends over a longer period. Blood glucose
levels are measured for up to 3, 4, or even 5 hours after glucose ingestion.
• Use: Helpful in cases where more detailed information on glucose metabolism is needed,
such as in complex cases of hypoglycemia.
3. GCT (Glucose Challenge Test)
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• Procedure: The patient drinks a glucose solution (usually 50 grams), and blood sugar
levels are measured after one hour. Fasting is not required.
• Use: Primarily used as a screening test for gestational diabetes around the 24th to 28th
week of pregnancy. If the result is abnormal, an OGTT may be recommended for definitive
diagnosis.
4. IV GTT (Intravenous Glucose Tolerance Test)
• Procedure: Glucose is administered intravenously, and blood glucose levels are measured
at specified intervals.
• Use: Less common, used in special situations where the standard oral test is not suitable,
such as for patients with gastrointestinal issues that affect glucose absorption.

C. HBA1c (ONLY DEFINITION)

• Hemoglobin A1c (HbA1c) is defined as a form of hemoglobin that is covalently bonded to
glucose. This glycation process occurs when glucose in the blood attaches to the hemoglobin
in red blood cells.
• The level of HbA1c in the blood serves as an indicator of the average blood glucose
concentration over the lifespan of the red blood cells, typically around 120 days.
• It is a crucial biomarker used for assessing long-term glycemic control in individuals with
diabetes.

HYPOGLYCEMIA-DEFINITION & CAUSES

DEFINITION:
• Hypoglycemia refers to a condition where blood glucose levels fall below the normal range.
• This reduction in blood sugar can affect various body functions, as glucose is a primary energy
source for the body, especially the brain.

CAUSES OF HYPOGLYCEMIA:
1. Excessive Insulin: In people with diabetes, taking too much insulin or other glucose-lowering
medications can cause hypoglycemia.
2. Inadequate Food Intake: Skipping meals, eating less than usual, or delays in eating can lead
to low blood sugar levels, especially in individuals taking insulin or certain diabetes
medications.
3. Excessive Exercise: Engaging in more physical activity than usual without adjusting food
intake or diabetes medication can lower blood sugar levels excessively.
4. Alcohol Consumption: Drinking alcohol, especially on an empty stomach, can interfere with
the liver’s ability to release glucose, leading to hypoglycemia.
5. Certain Medical Conditions: Some conditions like hormonal deficiencies, severe liver
disease, kidney disorders, or tumors that produce insulin (insulinomas) can cause
hypoglycemia.
6. Reactive Hypoglycemia: This occurs within a few hours after eating and is often related to
having pre-diabetes or being at risk for type 2 diabetes.