Carbohydrates are compounds containing C, H

and O. Carbohydrate is one of the major

compound as source of energy and also the
primary source of brain, erythrocytes and
retinal cell. Carbohydrates are stored primarily
as liver and muscle glycogen.
The classification of carbohydrate is based on
four different properties
 The size of the base carbon chain
 The location of the CO function group
 The number of sugar unit
 The stereochemistry of the compound

The nervous system including brain totally

depends on glucose from surrounding
extra cellular fluid (ECF) for energy
The liver, pancreas, and other endocrine
glands are all involved in the controlling the
blood glucose concentration within a narrow
range. During a brief fast, glucose is supplied
to the ECF from liver through glycogenolysis.
Control of blood glucose is under two major
hormones : insulin and glucagons both
produced by pancreas. Their action appose
each other.
 Insulin is the primary hormones
responsible for the entry of glucose into
cell. It is synthesized by the ß-cell of
islets of Langerhans in the pancreas.
When these cell detect an increase in
body glucose, they release insulin and
causes an increased movement of glucose
into the cells and increasesd glucose
metabolism.
Insulin is normally released when glucose
levels are high and is not released when
glucose levels are decreased. It decreased
plasma glucose levels by increasing the
transport entry of glucose in muscle and
adipose tissue by way of non specific
receptor.
 Glucagon is the primary hormone responsible
for increasing glucose levels. It is synthesized
by the α-cells of islet of Langerhans in the
pancreas and is released during stress and
fasting states. When these cells detect a
decrease in body glucose, they release
glucacon. Glucagon acts by increasing plasma
glucose levels by glycogenolysis in the liver
and an increase in gluconeogenesis. It can be
referred to as a hyperglycemic agent.

Hyperglycemia is an increase in plasma
glucose levels caused by an imbalance of
hormones. This condition known as
diabetes mellitus.

Diabetes Mellitus is actually a group of

metabolic diseases characterized by
hyperglycemia resulting from defect in
insulin secretion, insulin action or both.

Classification of diabetes Mellitus :
1. Diabetes type 1, is characterized by
inappropriate hyperglycemia primarily due to
pancreatic islet ß-cell destruction and proneness
to ketoacidosis caused an absolute deficiency.
This case constitutes only 10%-20% of all diabetes
and commonly occurs in childhood and
adolescence
2. Diabetes type 2, is characterized by
hyperglycemia due to an individual's resistance
to insulin with an insulin secretory defect. This
resistance result in a relative, not an absolute
insulin deficiency. This type is the majority of
diabetes case.
Most patient in this type are obese or have
abdominal fat
3.Other Specific types of diabetes, associated
with secondary conditions including genetic
defect of ß-cell function or insulin action,
pancreatic disease, endocrine disease, drug
and chemical induced and certain genetic
syndrome
4. Gestational diabetes mellitus (GDM), is any
degree of glucose intolerance with onset or
first recognition during pregnancy due to
metabolic and hormonal changes
Laboratory Finding in Hyperglycemia
 Increased glucose in plasma and urine
 Increased urine specific gravity (Density)
 Increased serum and urine osmolality
 Ketones in serum and urine
 Decreased blood and urine pH
 Electrolytes imbalance
Hypoglycemia involves decreased plasma glucose
levels and can have many causes, most reactive
(postprandial) and fasting (postabsorbtive). The
warning signs and symptoms of hypoglycemia are all
related to the central nervous system.
reactive (postprandial) such as
alimentary/gastrointestinal surgery characteristics
include a nonsuppressible insulin like activity in
which glucose levels drops below normal fasting
level fasting (postabsorbtive), individual has a loss
of glycemic control during in fasting state. This case
including insulin excess, oral hypoglycemic drugs
and prolonged alcoholic ingestion. Neonatal,
congenital and ketotic hypoglycemia occur in
children.
 Glucose oxidase : glucose react oxygen and
water with the present glucose axidase produce
gluconic acid and hydrogen peroxide. Hydrogen
peroxide react reduced chromogen by peroxidase
produced oxidized chromogen and water
 Hexokinase : Glucose and ATP with hexokinase
produced glucose-6-phosphat react NADP
become NADPH which has strong absorbance at
340 nm
 Clinitest/ Benedict : Glucose and some reducing
substance react Cu(II) produced Cu(I)oxide
The major lipids of the body triglycerides,
cholesterol, phospholipids and glycolipids
play a variety of biologic roles. Lipoprotein
are complex particles that interact with
many other metabolic pathway of the body.
Cholesterol is an unsaturated steroid alcohol
of high molecular weigh consisting of a
perhydrocyclopenthanthro-line ring and a
side chain of eight carbon atoms.
Characteristics of human lipoprotein :
 Chylomicron :diameter 80-1200 nm, density
<0,93 g/ml
 VLDL ; diameter 40-80 nm, density 0,93-
1,006 g/ml
 IDL : diameter 30-40 nm, density 1.006-1,019
g/ml
 LDL : diameter 18-30 nm, density 1,019-
1,063 g/ml
 HDL : diameter 5-12 nm, density 1,063-1,21
g/ml
Arteriosclerosis caused by cholesterols in the
wall of arteries. This lipid deposition starts
with thin layers called fatty streaks. The
fatty streaks develop over time into plaques
which partially block blood flow.
When plaques develop in legs or arm called
Peripheral Vascular disease (PVD), in heart
called Coronary Artery disease (CAD), in
vessel brain called Cerebrovascular disease
(CVD) associated with Stroke
Hyperlipoproteinemia are disease associated
with elevated lipoprotein levels while
Hypolipoproteinemia are disease associated
with decreased lipoprotein level. Devided into
low LDL and low HDL caused by physiology
stress, acute infection, surgical procedure
Hyperlipoproteinemia including
hypercholesterolemia, hypertriglyceridemia
and combined hyperlipidemia. All associated
with heart disease
Lipid Measurement used isolation/extraction
from samples and use some enzymes to
convert into substance to be measured.
Total lipid measurement used gravimetric
method but other substance like cholesterol
need spectrophotometric method like mass
spectrometry. Now, bioassay such as Enzyme
Like Immunobsorbent assay (ELISA), radio
immunodetection (RID) and radioimmuno
assay (RIA) prefer and more available.
VLDL, IDL, LDL and HDL characterized by
separation centrifugal method. The
supernatant analized by enzyme assay.
Fatty acid analysis is less used commonly
in routine clinical test. Usually use Gas
chromatography.