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С_st - glucose concentration in standard (calibration) solution (10 mmol/l);

D_оd - optical density of the sample solution;

D_st - optical density of a standard sample solution.

Conclusion.
Clinical diagnostic value:

Blood glucose levels are regulated by the neuro-humoral route. In a number of conditions, there is an increase in blood glucose ­ hyperglycemia, as well as a decrease in glucose concentration ­ hypoglycemia.

Hyperglycemia is a common symptom in various diseases, primarily associated with damage to the endocrine system. This is, first of all, diabetes mellitus, as well as pheochromocytoma, thyrotoxicosis, acromegaly, gigantism, Cushing's syndrome, glucagon, somatostatin. It is observed with pancreatic diseases (acute and chronic pancreatitis, cystic fibrosis, hemochromatosis, pancreatic tumors), shock, burns. Hyperglycemia causes a large number of drugs. Physiological hypoglycemia is noted after physical exertion, with strong emotional arousal, increased adrenaline rush during medical manipulations

Hypoglycemia occurs in diseases and tumors (insulinoma) of the pancreas, glucagon deficiency, tumors of various organs (cancer of the adrenal glands, stomach, fibrosarcoma), severe liver damage, endocrine disorders (hypopituitarism, addison's disease, hypothyroidism), after gastroenectomy systems in premature babies, etc.

Of greatest practical importance is the determination of glucose in the blood for diagnosis, monitoring treatment and identifying the degree of compensation for diabetes.

Tests for the Topic: Regulation of carbohydrate metabolism.

Тest 1

MATCH THE EXACT CORRESPONDENCE

EACH QUESTION CORRELATES TO ONE ANSWER

Hormone action Glucose change

1) insulin а) decrease

2) adrenaline б) increase

3) ACTH

4) CTH

5) thyroxine

6) cortisol

Тest 2

FILL IN THE GAPS ответ:

The regulatory role of the concentration of end metabolites on metabolic processes is realized through their influence on the ________ center of key enzymes according to the principle of ________

Тest 3

CHOOSE ALL CORRECT ANSWERS

The mechanism of action of glucocorticoids on carbohydrate metabolism:

a) activation of the breakdown of glycogen

b) inhibition of gluconeogenesis

c) activation of gluconeogenesis

d) inhibition of glycogen breakdown

e) inhibition of glucose uptake by peripheral tissues

Тest 4

FILL IN THE GAPS ОТВЕТ

There are two types of glucosuria:

1) __________ 2) __________

Тest 5

CHOOSE ALL CORRECT ANSWERS

Mechanism of action of insulin:

а) enhances glycogen breakdown

b) enhances glycogen synthesis

c) enhances gluconeogenesis

d) inhibits gluconeogenesis

e) enhances the oxidation of glucose

f) enhances the permeability of cell membranes for glucose

g) converts glucose to lipids

Тest 6

FILL IN THE GAPS ответ:

The condition of the liver affects the metabolism of carbohydrates, since ______ and _______ glycogen processes take place in the liver .

Тest 7

CHOOSE ALL CORRECT ANSWERS

The mechanism of action of glucagon:

a) increased breakdown of glycogen

b) reduced glycogen breakdown

c) increased gluconeogenesis

d) reduction of gluconeogenesis

e) increased glucose oxidation in the cell

f) activation of lipogenesis

Тest 8

FILL IN THE GAPS ОТВЕТ:

The condition of the kidneys affects the metabolism of carbohydrates, as in the kidneys 1)_________ ________ 2)____________ take place

Тest 9

CHOOSE ALL CORRECT ANSWERS

ACTH mechanism of action

а) increased breakdown of glycogen

b) a decrease in the breakdown of glycogen

c) enhances the growth of the adrenal cortex

d) a decrease in gluconeogenesis (inhibits the synthesis of glucocorticoids)

e) increased gluconeogenesis (increases the synthesis of glucocorticoids)

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Тest 10

FILL IN THE GAPS ответ:

Regulation, in which there is a simultaneous switching on of one process and turning off another, is called __________

Тest 11

Choose all correct answers

Addison's disease - primary adrenal insufficiency, accompanied by:

а) increased synthesis of corticosteroids

b) a decrease in the synthesis of corticosteroids

c) a decrease in gluconeogenesis

d) increased gluconeogenesis

e) hypoglycemia, hyponatremia, hyperkalemia

f) hyperglycemia, hypernatremia, hypokalemia
Тest 12

FILL IN THE GAPS

Blood glucose levels with loading hyperglycemia usually do NOT exceed ____ - _____.


Тest 13

Choose all correct answers

Feochromocytoma (an adrenal tumor accompanied by increased secretion of norepinephrine and adrenaline) is characterized by:

а) hypoglycemia

b) hyperglycemia

c) increased glycogenolysis

d) a decrease in glycogenolysis

e) increased gluconeogenesis

Тest 14

FILL IN THE GAPS:

The production of the hormone by non-endocrine cells during tumor processes in the tissues is called _______________ production of the hormone
Тest 15

CHOOSE THE CORRECT ANSWER:

Increased glucose levels, increased level of fatty acids, increased amino acid breakdown, Na retention, redistribution of fat, skin hyperpigmentation can occur with:

а) increased synthesis of ACTH and melanocyte-stimulating hormone in Itsenko-Cushing's disease

b) increased synthesis of TSH

c) a decrease in the synthesis of ACTH and melanocyte-stimulating hormone

d) long-term treatment with corticosteroids

e) increase the synthesis of growth hormone

Тest 16

FILL IN THE GAPS:

The following types of hyperglycemia are distinguished:

1)_______ 2)_______ 3)_______ 4) _________

Тest 17

CHOOSE ALL CORRECT ANSWERS:

Mechanism of action of insulin:

а) increases glucose oxidation

b) reduces glucose oxidation

c) increases glycogen synthesis

d) reduces glycogen synthesis

e) reduces gluconeogenesis

f) enhances glucose uptake into the cell

g) enhances the conversion of glucose to fat

Тest 18

FILL IN THE GAPS ответ:

blood glucose levels during alimentary hyperglycemia, as a rule, DO NOT exceed ____ - _______.

Тest 19

.CHOOSE ALL CORRECT ANSWERS:

The mechanism of action of glucocorticoids:

а)  activation of hexokinase

b) inhibition of glucose uptake by peripheral tissues

c) increased synthesis of glucose-6 phosphatase, fructose-1,6 diphosphatase, phosphoenolpyruvate carboxy kinase

d) a decrease in the synthesis of the same enzymes

e) inhibition of hexokinase.

Тest 20

FILL IN THE GAPS ответ:

The leading mechanism of self-regulation of metabolism in the cell is the action of a high concentration of final metabolites on the ________ center ___________ of enzymes by the principle of _______ _______.

Тest 21

CHOOSE ALL CORRECT ANSWERS:

Itsenko-Cushing's syndrome, due to hyperfunction of the adrenal cortex or prolonged treatment with corticosteroids, is characterized by:

Синдром Иценко-Кушинга, обусловленный гиперфункцией коры надпочечников или длительным лечением кортикостероидами, характеризуется:

а) hypoglycemia, hyponatremia, a decrease in the breakdown of amino acids, redistribution of fat

b) hyperglycemia, hypernatremia, increased breakdown of amino acids, redistribution of fat

c) lack of hyperpigmentation of the skin

d) hyperpigmentation of the skin

Тest 22

FILL IN THE GAPS:

the following 2 types of glucosuria are distinguished: _________ and ____________.

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Тest 23

CHOOSE ALL CORRECT ANSWERS:

Secondary adrenal insufficiency caused by ACTH deficiency is characterized by:

a) hypoglycemia, hyponatremia, hyperkalemia \b) hyperglycemia, hypernatremia, hypokalemia

c) enhanced skin pigmentation

d) lack of hyperpigmentation of the skin.
Тest 24

FILL IN THE GAPS ответ:

The most specific method for determining glucose in the blood and urine is the ____________ method

Тest 25

CHOOSE ALL CORRECT ANSWERS:

Primary aldosteronism - increased production of aldosterone (Conn syndrome) is characterized by:

а) Na retention, contributing to the development of hypertension, hypervolemia and edema, alkalosis, loss of K, leading to muscle weakness

b) loss of Na, hypotension, hypovolemia, acidosis, hyperkalemia

c) the appearance of hyperpigmentation of the skin

d) lack of hyperpigmentation of the skin

Тest 26

FILL IN THE GAPS:

A decrease in blood glucose is due to the hormone _________.

Тest 27

CHOOSE ALL CORRECT ANSWERS:

Negative nitrogen balance can occur with excess hormones:

a) insulin b) cortisol c) thyroxine d) prolactin e) glucagon

Тest 28

FILL IN THE GAPS ответ:

Treatment with corticosteroid drugs will lead to a decrease in the production of __________ hormones and _________ pituitary hormone

Тest 29

CHOOSE ALL CORRECT ANSWERS

Mechanism of action of insulin

a) promotes the transfer of glucose transporters from vesicles to the membrane

b) induces glycogen synthetase synthesis

c) activates hexokinase

d) inhibits hexokinase

e) increases the synthesis of acetyl coenzyme A carboxylase

f) reduces the synthesis of acetyl coenzyme A carboxylase

g) reduces the synthesis of glucose-6-phosphatase, fructose-1,6-diphosphatase, phosphoenol-pyruvate carboxylase

Тest 30

FILL IN THE GAPS:

Blood glucose levels usually do not exceed __-__ in case of physiological hyperglycemia

KEYS FOR THE SECTION:

«CARBOHYDRATE EXCHANGE REGULATION»

Тest 1 –1а; 2,3,4,5-b Тest 2 - allosteric, response Тest 3 – c,e Тest 4 –renal, extra-renal Тest 5 – b,d,e,f,g Тest 6 – decay and synthesis, gluconeogenesis Тest 7 –а,c Тest 8 – glucose reabsorption, gluconeogenesis Тest 9 –c,e Тest 10 - reciprocal Тest 11 – b,c,e Тest 12 –10-11 mmol/l Тest 13 –b, c Тest 14 - ectopic Тest 15 –а

Тest 16 – alimentary, stressful/loading, physiological, pathological Тest 17 – а,c,e,f, g Тest 18 - 10-11 mmol/l Тest 19 –b,c,e Тest 20 – allosteric, key, ressponse Тest 21 –b, c Тest 22 – renal, extrarenal Тest 23 –а, d Тest 24 - glucose oxidase Тest 25 – а, d Тest 26 - insulin Тest 27 –b,c Тest 28 – corticosteroid and ACTH (adrenocorticotropic) Тest 29 –а,b,c, e,g Тest 30 - 10-11 mmol/l

1.Topic «Carbohydrate metabolism».

Situational problems solution.

Venue: Chair of Biochemistry.

Duration ­180 minutes.

2.Objectives: to teach students independent work with literature on the proposed topic through solving situational problems.

3. Specific tasks:

3.1. The student must know:

3.1.1. Digestion and absorption of carbohydrates in the digestive tract.

3.1.2. Glycogen exchange, glycolysis, gluconeogenesis.

3.1.3. Stages of aerobic dichotomous oxidation of glucose, the role of vitamins and inhibitors. 3.1.4. Apotomic oxidation of glucose.

3.1.5. Hormonal and metabolic regulation of carbohydrate metabolism.

3.2. The student must be able to:

3.2.1. To analyze, summarize and state literary material.

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3.2.2. Evaluate and interpret biochemical laboratory research data (glucose, pyruvate, lactate, ketone bodies in the blood and urine, amylase and glucose-6-phosphatase activity in the blood) in order to use them in the diagnosis of various diseases.

The student must have the skills to: knowledge to evaluate the results obtained by the laboratory and interpret the data.

4. Motivation. The knowledge acquired at the class is necessary for understanding the mechanisms of the development of pathological conditions associated with the processes of carbohydrate metabolism disturbance (for example: diabetes mellitus, glycogenosis, consequences of hypovitaminosis).

5. Assignment for self-study.

Study recommended reading list, using questions for self-study.

5.1. Revise the lecture material on all topics of carbohydrate metabolism.

5.2 Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 545-549, 572-592. 2011. -С. 308-310, 325-328,356-363, 579-585.

5.3. Березов Т.Т., Коровкин Б.Ф. «Биологическая химия» М., Медицина, 1998 г., глава «Метаболизм углеводов» С.319-362, глава «Биомембраны и биоэнергетика» С.305-313.

5.4 Подготовиться к лабораторной работе по методическим пособиям: Учебно-методическое пособие к практическим занятиям по биологической химии, часть 2, Санкт-Петербург, 2013

5.3. Additional material handed out at the class.

6. Questions for self-study.

6.1. Digestion and absorption of carbohydrates in the digestive tract. Diagnosis of violations.

6.2. Diseases associated with impaired glycogen metabolism. Diagnosis of violations

6.3. Glycolysis and gluconeogenesis.

6.4. The main stages of aerobic dichotomous oxidation of carbohydrates, inhibitors.

6.5. The role of water-soluble vitamins in the aerobic dichotomous oxidation of carbohydrates.

6.6. Sources and ways of using acetyl-CoA in the cell.

6.7. The chain of terminal oxidation of carbohydrates.

6.8. Inhibitors and uncouplers of tissue respiration, their mechanism of action.

6.9. Metabolic level of regulation of carbohydrate metabolism.

6.10. Hormonal level of regulation of carbohydrate metabolism. The role of insulin and other hormones in the regulation of carbohydrate metabolism.

6.11. Pentose phosphate glucose oxidation cycle. The value of NADPN + H⁺ in the functioning of the antioxidant system of the body.

6.12. Type 1 and type 2 diabetes mellitus, causes, metabolic disorders accompanying diabetes mellitus, diagnosis.

7.4. Example of test control.
Question card 2. CHOOSE ALL CORRECT ANSWERS:

For diabetes the following are characteristic:

1) hyperglycemia 4) oliguria 7) lowering blood pH

2) hypoglycemia 5) polyuria 8) increase in blood pH

3) glucosuria 6) ketoacidosis

Problem 1

The disease is hereditary, children suffer from the moment of birth, the clinical picture is diarrhea, flatulence, frothy, acidic stools.

The child refuses to breast-feed. In the urine, lactose is detected - lactosuria, complete recovery does not occur.

Pathomorphological changes: malnutrition, in severe cases, degenerative changes in the renal and hepatic parenchyma are observed.

What disease can we talk about? What loading tests should be performed for diagnostics? What diet is needed for this child?

Literature:

1) В.В. Долгов, А.С. Аметов, К.А. Щетникович, А.П. Ройтман, Т.Ю. Демидова. Лабораторная диагностика нарушений обмена углеводов, сахарный диабет. М., ЛАХЕМА, 2000 г. 63 с.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 312-315 2011. -С. 308-310.

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Problem 2.

The disease is hereditary, manifested from the moment of birth. The clinical picture - carbohydrate intake is accompanied by diarrhea, flatulence. If you follow a strict diet, the symptoms are smoothed out. Test with a load of carbohydrates is positive (there is no increase in blood glucose) when taking sucrose, maltose, lactose, glucose.

What kind of pathology are we talking about? What is the dietary correction?

Literature:

1) В.В. Долгов, А.С. Аметов, К.А. Щетникович, А.П. Ройтман, Т.Ю. Демидова. Лабораторная диагностика нарушений обмена углеводов, сахарный диабет. М., ЛАХЕМА, 2000 г. 63 с.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 312- 315, 2011. -С. 308-310.
Problem 3.

The disease is hereditary. Children suffer from the moment of birth. Refusal of feeding, diarrhea, flatulence, vomiting, hepatosplenomegaly, ascites, hemorrhagic diathesis, hypoalbuminemia, increased activity of transaminases in the blood serum, galactosemia, galactosuria, proteinuria, aminoaciduria. Hyperbilirubinemia, cataract. The course is severe, it can end fatally. With a therapeutic diet and with age, the symptoms disappear. Fatty degeneration, vacuolization, a change in the nuclei of hepatocytes, fibrosis, cirrhosis of the liver, degeneration of the renal tubular epithelium. Perivascular cerebral edema.

What kind of pathology are we talking about? What is the dietary correction?

Literature:

1) Т.Т. Березов, Б.Ф.Коровкин. Биологическая химия. М., Медицина, 1998 ., С.337-338

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 366-369. 2011. -С. 361-363.
Problem 4.

The disease is hereditary. Children suffer from the moment of birth. Refusal of feeding, vomiting, hepatosplenomegaly, ascites, sweating, cramps. Fructosemia, fructosuria, hypoalbuminemia, hyperbilirubinemia. Increased activity of transaminases in serum. The course is severe, up to coma and death. Dystrophic changes in hepatocytes, fibrosis or cirrhosis.

What kind of pathology are we talking about? What is the dietary correction?

Literature:

1) Т.Т. Березов, Б.Ф.Коровкин. Биологическая химия. М., Медицина, 1998 ., С.335-336

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 364-366, 2011. -С. 358-361.
Problem 5.

The patient complains of increased thirst, dry mouth, a large amount of urine, increased appetite, weight loss, skin itching, general weakness, pain in the epigastric region of the girdle.

Laboratory examination results:

Fasting blood

Amylase-50 units / l (normal - 27-131 units / l), (16-30 g / l * h)

Glucose - 11.4 mmol / l

Ketone bodies - 12.9 mg / dl (normal 1-3 mg / dl)

PH - 7.29

In urine:

Glucose – 31 g/day

Ketonuria (+) - there are ketone bodies in the urine

What disease can you think of in this case? Explain clinical symptoms and abnormalities in blood and urine from a biochemical point of view.

Literature:

1) В.В. Долгов, А.С. Аметов, К.А. Щетникович, А.П. Ройтман,

Т.Ю. Демидова. Лабораторная диагностика нарушений обмена углеводов, сахарный диабет. М., ЛАХЕМА, 2000 г. 63 с.

2) Биохимия: Учебник/ Под ред. Е.С. Северина. – М.: ГЭОТАР-МЕД, 2003. -С. 580, 592-597, 2011. -С. 568, 580- 585.

3) Мазовецкий А.Г., Великов В.К., Сахарный диабет. М., Медицина,

1987., С.3, 27-42, 61-65.
Problem 6.

Blood samples were taken from two patients A. and B. with diabetes mellitus to determine the concentration of “C” peptide.

In patient A., C-the peptide was found in trace amounts.

In patient B., the concentration of C-peptide is within normal limits.

What is a “C” peptide, for what purpose is it determined?

What type of diabetes was found in patient A and B?

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