SIDEBOI NOTES v1.

CARBOHYDRATES

Hormone Source Functions

Glucagon Alpha Cells Promotes Glycolysis
Insulin Beta Cells Promotes entry of glucose to tissue cells
Somatostatin Delta Cells Inhibits the action of insulin, glucagon, and
growth hormone

Conversion Processes
1. Glycolysis – Glucose to Pyruvate/Lactate + Energy (ATP)
2. Glycogenolysis – Glycogen to Glucose
3. Glycogenesis – Glucose to Glycogen
4. Gluconeogenesis – Non-carb sources to Glucose
5. Lipogenesis – Carbohydrates to Fatty acids

*Glucosuria occurs when plasma glucose exceeds renal threshold (*160 –

180mg/dl)

REFERENCE VALUES (Based on CDC)

Tests Normal Impaired Diagnosis
FBS 70-100 mg/dl 100 – 125 mg/dl >126 mg/dl

2-hour OGTT <140 mg/dl 140 – 199 mg/dl >200 mg/dl

RBS n/a n/a >200 mg/dl

HBA1c <5.7% 5.7 – 6.4% >6.5%

*RBS of <60mg/dl strongly suggests HYPOGLYCEMIA

Glucose Value Description

65 – 70 mg/dl Increased Glucagon
50 – 55 mg/dl Observable symptoms
40 mg/dl Critical
20 – 30 mg/dl CNS Dysfunction
 Diabetes Mellitus Type I vs Type II
TYPE I TYPE II
Onset Juvenile-onset Adult-onset
Other Name Insulin dependent DM Non-insulin dependent DM
Pathogenesis Autoimmune Lifestyle related
Beta-cell destruction Insulin resistance
Ketoacidosis Yes Rare
C-peptide Levels Low Normal

Glycogen Storage Diseases

Type/Glycogen Storage Dss Enzyme Deficient
Ia/Von Gierke Glucose-6-phosphatase
II/Pompe Lysosomal-1,4-glycosidase
III/Cori Forbes Debranching enzyme
IV/Andersen Branching enzyme
V/McArdle Muscle phosphorylase
VI/Hers Hepatic phosphorylase
VII/Tarui Phosphofructokinase
XI/Fanconi-Bickel Glucose transporter 2

*Rate of Glycolysis
• 7mg/dl at Room Temp (7 rooms)
• 2mg/dl at Ref Temp (2 refs)

*Glucose Levels
• Whole Blood < Venous < Capillary
• Arterial = Capillary

*As little as 10% contamination of 5% dextrose will increase the glucose in a

blood sample by 500mg/dl or more

Chemical Methods
Folin Wu Phosphomlybdenum blue
Alkaline Copper Nelson Somogyi Arsenomolybdenum blue
Reduction Method Neocuproine Yellow or Yellow orange
cuprous-neocuproine complex
Alkaline Ferric Inverse Colorimetry Reduction of yellow
Reduction Method ferricyanide to colorless
(Hagedorn Jensen) ferrocyanide
Condensation Ortho-toluidine Method (Dubowski Method) and
Method Schiff’s Base
Enzymatic Methods
Glucose Oxidase Method
(Saifer-Gernstenfield Method)
Hexokinase Method
Glucose Measurements
1. Random Blood Sugar
2. Fasting Blood Sugar
3. 2-hour Post Prandial Blood
Sugar
4. Glucose Tolerance Test
5. Glycosylated Hemoglobin
6. Glycosylated Albumin
*Routine Tests of Diabetes Mellitus (Matamis sa FHM)
▪ FBS (Screening Test)
▪ HBA1c (Monitoring)
▪ Microalbuminuria Test (Renal Complications)
➢ Measures B-D glucose
➢ Most Common Method
➢ Glucose Oxidase and Peroxidase are
the 2 enzymes involved
➢ Reference and Most Specific Method
➢ Makes use of Hexokinase and G6PD
▪ Requested during Insulin Shock
▪ For Patients with Diabetic Coma
▪ Measures overall Glucose Homeostasis
▪ Measures how well the body
Metabolizes Glucose
▪ Performed to diagnose Gestational DM
▪ Reflects the Average Blood Glucose
level over a period of 2-4 months
▪ Short Term Glucose Monitoring
LIPIDS and LIPOPROTEINS

Cut off Points for Serum Cholesterol

AGE GROUP MODERATE RISK HIGH RISK
2 – 19 >170mg/dl >185mg/dl
20 – 29 >200mg/dl >220mg/dl
30 – 39 >220mg/dl >240mg/dl
40 and above >240mg/dl >260mg/dl

Acceptable CV
Analyte CV
Cholesterol < 3%
Triglyceride < 5%
HDL – Cholesterol < 4%
LDL - Cholesterol < 4%

Different Lipids and Lipoproteins

1. HDL ▪ Good Cholesterol

▪ Reverse Cholesterol Transport
▪ Highest Protein and Phospholipid content
2. VLDL ▪ Endogenous TAG
▪ 2nd most atherogenic LPP
3. LDL ▪ Bad Cholesterol
▪ Most atherogenic LPP (if Lipid = Chole)
▪ Highest Cholesterol content
4. Chylomicrons ▪ Exogenous/Dietary TAG
▪ Highest TAG content
▪ Non-atherogenic

5. IDL, Lp(a) ▪ Minor LPP

6. Lp(a) ▪ Sinking pre-beta LPP
7. B-VLDL ▪ Floating beta LPP
8. LpX ▪ Lipoprotein found in obstructive jaundice
Reference Values for LDL
LDL Value Description
<100 mg/dl Optimal
100 – 129 mg/dl Near Optimal
130 - 159 mg/dl Borderline
160 – 189 mg/dl High
>190 mg/dl Very High

Reference Values for HDL

Low Risk Protective High Risk
>40 mg/dl >60 mg/dl <40 mg/dl

Apo-A1 – HDL
Apo-B48 – Chylomircon (CM)
Apo-B100 – LDL/VLDL

*Overnight Refrigeration
Floating Creamy Layer: CM
Floating Creamy Layer and Turbid Plasma: CM & VLDL

Reference Values for Triglycerides

TAG Value Description
<150 mg/dl Normal
150 – 199 mg/dl Borderline High
200 - 499 mg/dl High
>500 mg/dl Very High

Triglyceride Levels
Clear Plasma <200 mg/dl
Hazy/Turbid Plasma >300 mg/dl
Lactescent Plasma >400 mg/dl
Opaque and Milky Plasma >600 mg/dl
Acute Pancreatitis >1000mg/dl

Ultracentrifugation
▪ Reference Method for Lipoprotein Quantification
▪ Expressed in Svedberg Units

Most Dense Least Dense

HDL > LDL > VLDL > Chylomicrons
 Electrophoresis
▪ Uses cellulose acetate at ph 8.6

Origin Anode
Chylomicrons > LDL > VLDL > HDL

Friedrickson’s Classification of Dyslipoproteinemias

Type/Name Elevated LPP
I/Familial LPL deficiency CM
IIa/Familial Hypercholesterolemia LDL
IIb/Familial Combined Hyperlipidemia LDL, VLDL
III/Familial Dysbetalipoproteinemia IDL, (+) B-VLDL
IV/Familial Hypertriglyceridemia VLDL
V/Endogenous Hypertriglyceridemia CM, VLDL

PROTEINS

Protein Function
1. Prealbumin ▪ Indicator of Malnutrition
2. Ceruloplasmin ▪ Carrier of Copper
3. Haptoglobin ▪ Carrier Hemoglobin
4. Hemopexin ▪ Carrier Heme
5. Transferrin ▪ Carrier of Iron
6. Fibrinogen ▪ Found between beta and gamma
7. Fibronectin ▪ Predict the short-term risk of premature
delivery
8. B-Trace Protein ▪ Accurate marker of CSF Leakage

*Negative Acute Phase Reactants:

▪ Prealbumin
▪ Albumin
▪ Transferrin

*Microalbuminuria – Early indicator of Glomerular dysfunction and precedes

nephropathy associated with type 1 DM
Protein Methods and Reagents
Kjeldahl Method
Biuret Method
Most Specific, Sensitive
dye in binding method
Protein Dyes for
Electrophoresis
Reference Methods
Lipoprotein
Cholesterol
Triglyceride
Glucose
Glomerular Filtration Rate
BUN, Creatinine, Uric Acid
▪ Measures nitrogen content of protein
▪ Measures amount of peptide bonds
▪ Bromcresol Purple
▪ Coomassie Brilliant Blue, Amido Black,
Ponceau S
Ultracentrifugation
Abell Kendall Method
Modified Van Handel
Hexokinase
Inulin Clearance
Isotope Dilution Mass
Spectrophotometry (IDMS)