1. Carbohydrate Storage and Disorders
By Jennifer Turley
and Joan Thompson
© 2013 Cengage

2. Presentation Overview
STORAGE
Blood Sugar (glucose)
Starch vs. Glycogen
Glycogen in detail
Blood sugar regulation
Insulin & Glucagon
DISORDERS
Lactose Intolerance & Lactose Mal-digestion
Hypoglycemia
Diabetes

3. What is Glucose Used for?
Immediate carbohydrate energy &/or glycogen storage (Liver & Muscle).
Brain, central nervous system (CNS), & red blood cell (RBC) function (liver glycogen).
Requires a minimum of grams carbohydrate day (continuous).
Muscle functioning (muscle glycogen).
Fat synthesis (excess energy intake).

4. What is Glycogen? Whole grain complex carbohydrates are best
The storage form of glucose, “animal starch”.
Made from dietary carbohydrate sources.
All carbohydrate is converted to glucose then stored as glycogen or used immediately.
Diets should be planned to meet the 45-65% of Calories AMDR & minimally the DRI for carbohydrate (130 gm/day for adults).
Whole grain complex carbohydrates are best
Carbohydrate is protein sparing

5. Where is Glycogen Stored?
The Liver (100 grams; 400 Calories).
Is used for blood sugar (glucose) regulation.
The Muscle (1-4 grams/100 grams of muscle).
The level increases with high carbohydrate diets & exercise.
Is used for the working muscle.

6. How Does the Body Regulate Blood Sugar?
By hormones that are produced in the pancreas.
The hormones effect the liver & muscle cells.
Insulin: decreases blood sugar levels.
Glucagon: increases blood sugar level.

7. Blood Sugar Regulation

8. Blood Sugar Regulation

9. Carbohydrate Related Disorders
Lactose Intolerance & Lactose Mal-digestion
Hypoglycemia
Diabetes

10. Lactose Intolerance Physiology:
Lactase deficiency (completely missing in “intolerance” while low activity/levels in “mal-digestion”) is strongly tied to evolution with several gene mutations identified.
Symptoms: Gas, bloating, cramps, diarrhea.

11. Lactose Intolerance

12. Dairy Products and Lactose Intolerance
Use a product like lactaid
Consume yogurt with live cultures
Consume aged cheese OR
Avoid dairy products

13. Allergy vs. Intolerance
Lactose intolerance & mal-digestion are due to an inability to digest milk sugar (lactose) not an allergic reaction to milk protein (casein).
An allergy elicits an immune reaction & involves antigens & antibodies.
Antibody: Protein structures produced by immune cells that inactivate antigens (allergens).
Antigen (allergen): Foreign protein substances that elicit an immune reaction.
Allergic responses cause the formation of mucous in the respiratory tract, GI distress &/or hives.

14. Antibody and Allergen in an Allergic Immune Response

15. Hypoglycemia low blood sugar
Reactive: Blood sugar levels drop after eating sugar.
Too much insulin is secreted in response to sugar consumption. Hyperinsulinemia.
Spontaneous: Liver stores of glycogen are depleted, the ability to maintain blood sugar is diminished.
Happens to everyone in between meals or when food has not been consumed. 4-6 hours during the day, hours with sleep.
Drug Induced: Low blood sugar from a drug reaction.
Improper insulin or oral hypoglycemic drug use with diabetes.
Anti-inflammatory and thyroid medications are known to cause hypoglycemia.

16. Diabetes A chronic disease
Is characterized by hyperglycemia (high blood sugar).
Affects >20 million Americans, many unaware.
Increases heart disease, stroke, kidney disease, retinopathy, and neuropathy.
Decreases life expectancy.
Occurs as type 1 or type 2 diabetes.

17. Type 1 Less common ~5% of cases Juvenile onset
Is more difficult to control
Insulin administration is essential in the control of blood sugar (Insulin-dependent diabetes)
Is due to a genetic and/or viral factor causing auto immunity directed against the pancreatic beta cells

18. Physiology of Type 1 Diabetes
Blood
Stream
Antibodies attack the insulin producing cells of the pancreas.
No insulin is made.
Blood glucose/sugar levels are high.
Liver & muscle cells cannot take up glucose because there is no insulin to bind the cell receptor.
Pancreas

19. Physiology of Type 1 Diabetes
Insulin is injected into soft tissue & works its way into the blood stream
Blood
Stream
5. Insulin is injected.
6. The insulin receptor on
liver and muscle cells
bind to insulin &
take up glucose.
7. Blood sugar levels decline.
Pancreas

20. Type 2 Very common ~95% of cases Typically adult onset
May be controlled with lifestyle changes & oral hypoglycemic agents
Is caused by insulin resistance (decreased insulin receptor response)
Is predisposed by obesity & genetics.

21. Physiology of Type 2 Diabetes
1. The pancreas produces
insulin.
2. Blood glucose/sugar
levels are high.
3. The insulin receptor
on the liver and muscle
cells are insensitive to
the insulin.
Blood
Stream
Pancreas

22. Physiology of Type 2 Diabetes
Blood
Stream
1. Oral Hypoglycemic
drugs are used to make
the cells respond to the
insulin.
2. Blood sugar levels decline.
Drug
Drug pill is taken orally & works it’s way into the blood stream
Pancreas

23. Indications of Diabetes
Fasting glucose level ≥ 126 mg/dl.
2 hour post prandial (fed) blood glucose level ≥ 200 mg/dl.
Hyperglycemia
Normal Blood Glucose is mg/dl
Pre-Diabetes is mg/dl

24. Glucose Tolerance Test Measures Carbohydrate Metabolism
Normal diet for 3 days prior to test.
Baseline fasting blood sugar level. (Levels ≥126 mg/dl indicate diabetes).
Glucose load. 1 gm carbohydrate /Kg body weight or a max of 100 gm for adults.
Monitor blood sugar every half hour for six hours.

25. Overweight Contributes to Hyperglycemia type 2 diabetes

26. Case Studies: Dick & Jane50
100
150
200
250
300
-12 -9 -6 -3
Dick's Blood
Sugar (mg/dl)
Dick's Weight (lbs)
months
Dick’s blood sugar dropped from >600 mg/dl to mg/dl over 12 months with weight loss from 262 to 233 lbs.
Jane’s blood sugar went up from 128 mg/dl to 240 mg/dl after gaining an extra 10lbs. Over 24 months she gradually lost 100 lbs and brought her blood sugar to normal.
DICK
JANE

27. Food Composition The Glycemic Response/Index
Simple sugars & foods with a high glycemic index burn up fast & elicit an insulin response.
Complex carbohydrates sustain energy better.

28. What is the Glycemic Response/Index?
The rise in blood sugar in response to food as compared to glucose.
Glucose is assigned 100.
The Glycemic Index of a food can be useful to anyone concerned with blood sugar control.

29. Glycemic Response of Foods
Those with diabetes should eat foods that have a lower glycemic response or slower entrance of glucose into the blood stream.
Foods with high protein, fat, & fiber lower the glycemic response.

30. Glycemic Index of Foods

31. Summary Glucose is required by the brain, RBCs & CNS for energy (ATP).
Carbohydrate is the preferred energy source of the body.
All carbohydrate is converted to glucose for energy.
Excess carbohydrate is stored as glycogen. (liver & muscle)
If glycogen stores are full, excess carbohydrate is stored as fat.

32. Summary
Liver glycogen maintains blood sugar for brain, RBCs & CNS function.
Muscle glycogen maintains the working muscle in high intensity exercise.
The hormones insulin & glucagon regulate blood sugar levels.
Insulin decreases while glucagon increases blood sugar.

33. Summary Lactose intolerance occurs when the enzyme lactase is missing.
Milk allergy involves immunity.
Hypoglycemia is low blood sugar. Can be reactive, spontaneous, or drug induced.
Hyperglycemia is a sign of diabetes.

34. Summary Diabetes occurs as type 1 & type 2.
Unmanaged diabetes has health implications.
Individuals with diabetes should consider the glycemic response of foods for diet planning.
Selecting low glycemic index foods is useful in controlling blood sugar rises.
References for this presentation are the same as those for this topic found in module 3 of the textbook