CARBOHYDRATE METABOLISM

BLOOD GLUCOSE

Biochemistry 2
Code (4131 )
By the end of this lecture, students are expected to know:

• Sources of blood glucose

• Regulation of blood glucose level
• Abnormalities of blood glucose level
BLOOD GLUCOSE
• Normal fasting blood glucose is 70-100 mg/dL, it increases
after meals but returns to fasting level within 2 hrs.
Sources of blood glucose:
• Dietary carbohydrates.
• Glycogenolysis (fasting for less than 18 hrs.).
• Gluconeogenesis (fasting for more than 18 hrs.).
Regulation of blood glucose level
The different factors that regulate the blood glucose include:
A-Regulation by different organs:
1-Gastrointestinal tract.
2-Liver
3-Kidney.
B- Regulation by hormones.
A-Regulation by different organs
1. Gastrointestinal tract:
• It controls the rate of glucose absorption.
• The maximum rate of glucose absorption is 1gm/kg body
weight/ hour.
• An average person weighing 70 Kg will absorb 70 gm glucose/
hour.
• Glucose given orally stimulates more insulin than intravenous
glucose.
• This may be due to secretion of glucagon-like substance by
the intestine, that stimulates β -cells of pancreas to secrete more
insulin.
2. Liver : (Role of liver in carbohydrate metabolism):
• The liver is the main blood glucostat, i.e. it tries to maintain
blood glucose level within normal as follows:
A. If blood glucose level increases,
The liver controls this elevation and decreases it through:
• Oxidation of glucose via major and minor pathways.
• Glycogenesis.
• Lipogenesis.
B. If blood glucose level decreases,
The liver controls this drop and increases it through:
• Glycogenolysis.
• Gluconeogenesis
3. Kidney:
• All glucose in the blood is filtered through the kidneys, it then
completely returns to the blood by tubular reabsorption.
• If blood glucose exceeds a certain limit (renal threshold),
it will pass in urine causing glucosuria.
• Renal threshold: it is the maximum rate of reabsorption of
glucose by the renal tubules. Normally the renal threshold for
glucose is 180 mg/100 mL.
B- Regulation by hormones.
1. Insulin (the only hypoglycemic hormone):
• Insulin is a protein hormone, secreted by the β -cells of the
islets of Langerhans of the pancreas.
Action of insulin:
• Insulin decreases blood glucose level by the following
mechanisms:
• It stimulates the oxidation of glucose as it stimulates
glycolysis by inducing the synthesis and activating all the
glycolytic key enzymes (GK, PFK & PK).
• It stimulates glycogenesis by enhancing the glycogen synthase
activity.
• It stimulates lipogenesis through the increases of glucose
uptake by adipose tissue.
• It stimulates protein synthesis.
• It inhibits glycogenolysis by inhibiting the glycogen
phosphorylase activity.
• It inhibits gluconeogenesis by suppressing effect on the key
enzymes of gluconeogenesis (enzymes of reversal of
glycolysis).
2. Anti-Insulin Hormones: (hyperglycemic hormones):
Growth Hormone:
• Secreted by anterior lobe of the pituitary gland.
• It elevates the blood glucose level by stimulating
gluconeogenesis and lipolysis.

Thyroxin:
• It elevates the blood glucose level by:
• Increasing the rate of absorption of glucose from intestines.
• Stimulating gluconeogenesis and glycogenolysis.
Epinephrine (adrenaline):
• It is secreted by the adrenal medulla
• It increases the blood glucose level by
increasing glycogenolysis and
gluconeogenesis in liver and lipolysis
in adipose tissues
Glucagon:
• It increases the blood glucose level by increasing
glycogenolysis and gluconeogenesis in liver.
Mechanism of Blood Glucose Regulation
(Glucose Homeostasis)
• The blood glucose level is regulated by the balance between
the action of insulin and anti-insulin hormones.
• The brain depends on plasma glucose as a major metabolic
fuel under most conditions.
• Plasma glucose is normally regulated to maintain a level that
ensures glucose transport into the brain at adequate rates.
After a carbohydrate meal:
The blood glucose level increases, stimulating the secretion
of insulin which tends to decrease the blood glucose level by
its various actions.
During fasting:
• The blood glucose level is low; this stimulates the secretion
of the anti-insulin hormones which lead to increasing the
blood glucose level.
The net result is a condition of glucose equilibrium, or what
we call the homeostatic mechanism.
Abnormalities of Blood Glucose Levels
These may be in the form of:
1-Hyperglycemia:
It is the rise of blood glucose level above the normal level.
Causes
• Deficiency of insulin:
- Diabetes mellitus.
-Pancreatictomy (total or subtotal).
• Hypersecretion of anti-insulin hormones.
2-Hypoglycemia:
• It is the decrease in blood glucose level that leads to
symptoms of sympathetic nervous system stimulation.
• An abnormally low plasma glucose level is usually
defined as < 50 mg/dL:
• At a level of 50 mg/dL, convulsions occur, and at a level
of 30 mg/dL, coma and death result.
Causes of hypoglycemia
i. Excess insulin:
• Overdose of insulin.
• Tumor of B-cells of pancreas (insulinoma).
ii. Hyposecretion of anti-insulin hormones:
• This may be due to hypo-functions of the pituitary gland,
adrenals and thyroid gland. In all these conditions, insulin
acts unopposed causing lowering of blood glucose
iii. Liver disease:
- In this case, hypoglycemia is due to decreased glycogen
stores and impaired gluconeogenesis.
Clinical manifestations of hypoglycemia
• The clinical manifestations of hypoglycemia include:
• Symptoms including sweating, irritability, faintness,
palpitations, and hunger.
• CNS manifestations including confusion, visual disturbances,
convulsions, and coma.
• Hypoglycemic coma commonly causes an abnormally low
body temperature.
Glucosuria (glycosuria)
Glucosuria is the presence of detectable amount of glucose in
urine (>30 mg/dL).
Causes:
A. Hyperglycemic glucosuria:
It occurs when blood glucose level exceeds the renal threshold
(180 mg/dL). It is caused by:
1-Diabetes mellitus.
2-Emotional or stress glucosuria (epinephrine glucosuria):
❖ Epinephrine secretion is increased, this leads to hyperglycemia,
if exceeds the renal threshold causes glucosuria.
3-Alimentary glucosuria;
❖ It is due to increased rate of glucose absorption from the
intestine as in cases of gastrectomy or gastrojejunostomy
B. Normoglycemic or renal glucosuria:
1- Congenital renal glucosuria
❖ It is due to congenital defect in renal tubular reabsorption of
glucose.
2- Acquired renal disease (e.g. nephritis).
3- Pregnancy glucosuria:
❖ It appears during pregnancy and disappears later on after labor.
Thank You