2. Fructose F-1-PO 4 1) Glyceraldehyde Phospatase 2) dihydrous aceton PO 4 ATP ADP F-1,6 diPO 4 + Glyceraldehyde-3-PO 4 F-1-PO 4 Isomerase G-6-PO 4 Phospatase Glucose ATP ADP

4. NAD NADH+H dehydrogenase Aldose reductase CHO | H-C-OH | R CH2OH | H-C-OH | R CH 2 OH | C=O | R NADHph + H+ Glucose Sorbitol Fructose

6. UDP - Galactose ( Activedonnes) : 1- Glycolipid synth. 2- Lactose formation. 3- Mucopolysaccharide. 4- glycosaminoglycone ( GAGs ).

9. Blood Glucose Plasma Glucose level: A.Fasting level 70-110 mg/dl. B.one hour after meal 120-150. C.two hours after carbohydrate meal (post prandial ) till 140.

10. Source of blood glucose: Factors that add glucose to blood 1. Carbohydrate diet. 2. Glycogenolysis. 3. Gluconeogensis.

11. I.Regulation of Blood Glucose blood glucose is maintained 70-110mg because: hyperglycemia (increase blood glucose) can cause cerebral dysfunction but its effect on extra cellular osmolarity. II. hypoglycemia cause impairment of cerebral function as brain is very dependent on blood glucose for energy

12. Regulation of Blood Glucose Regulation of glucose 1- hormonal 2- hepatic 3-renal 1) Hormonal regulation:

15. 2) Hepatic regulation Blood glucose is filtered in glomular filtrate and reabsorbed again. * If blood glucose exceeds certain limit (180 mg/dl), glucose will increase and exceed the capacity of tubular enzyme to reabsorb. So it will appear in urine (called glycouria). Renal Threshold 3) Renal regulation

16. II) Hypoglycemia If blood glucose decreased (less than 45 mg/dl), that would cause cerebral dysfunction if prolonged cause death (so "GLUCAGON" must be taken) Symptoms : Headache, Confusion, Hunger, Anxiety, Slurred speech, palpitation Causes : 1. Fasting 2. due to organ disease : - Pancreatic: insulinoma (Tumor) - liver disease: hepatic carcinoma 3. Glycogen storage disease 4. Starvation 5. Adrenocortical disease (↓ epi)

18. It is a state of chronic hyperglycemia (Glucose urea). Relative or absolute deficiency of insulin hormone Biochemical disturbance of diabetes mellitus 1) Carbohydrate: ↓Glucose uptake by tissue ↓oxidation ↑gluconeogenesis and↑glycogenolysis ↓intracellular glucose →hunger (polyphagia) * Increase blood glucose by: a) Increase plasma osmolarity → dehydration. b) Dehydration of brain cells (coma). c) Dehydration of body cells "thirst" (polydepsia). d) Glucose urea: frequent urination loss of vitamin B 1 loss of K +, Na + Protein metabolism: * Increase protein breakdown. * Increase gluconeogensis (amino acid convert to glucose) 1.phosphatase release 2. excess breakdown of tissue protein (muscle wasting) 3. decrease antibody. 4. poor wound healing.

20. Non - insulin dependent NIDDM Insulin - dependent IDDM Type 2 (adult-onset Diabetes) Type 1 (juvenile Diabetes)names After 35 oldDuring childhoodAge of onset obesitythinNutriamial stute 80-90% of digorosed10-20% of diabetesPresalenes Very strongmoderategenetic Insulin resistance in insulin level β cell destroyed no insulinDefect in β cells RareCommonKetosis Hyperosmolar comaKeto acidosisAcute complications responsiveNo responseOral hypoglycogenic drugs Usually not reqairedAlways necessaryTreatment with insulin

21. 1. glucose tolerance test 2. fasting blood glucose not more than 110 mg/dl 3. two hrs post (prandial) must be within the normal fasting level. 4. Glycosylated hemoglobin (HbA1C) it is a glycated protein which results from simple non enzymatic reaction between globin part of HB and glucose, its level in the red cells is directly proportional to the blood glucose level at the time of formation of such cell, this level remains as it for the whole life span of red blood cells 120 days * It is useful for monitoring the degree of control of diabetes mellitus during last 8-12 weeks before the test. Normal 4 - 7.2% 5. plasma fructose amine Albumin under go glycosylation 6. Microalbuminurea early detection of D.M. in urine by special kits.

22. Renal threshold hours 1234 200 100 500 Glucose in blood 180 normal diabetic Glucose tolerance curve

23. Type of Coma The Cause & Effect of Coma on: Hypoglycemic ComaDiabetic Coma Insulin overdoseSever untreated D.MThe Cause The Effect on: NormalAcetone smellMouth NormalHyperventilationRespiration Rapid, strongRapid, weekPulse sweatDrySkin AbsentPresentUrine glucose AbsentPresentUrine acetone

24. Hypoglycemic comaDiabetic coma Insulin overdoseSevere untreated D.MCauses NormalAcetone smellMouth NormalHyperventilationRespiration Rapid, strongRapid, weekPulse SweetDrySkin AbsentPresent Urine glucose Absentpresent Urine acetone