CARBOHYDRATE

METABOLISM
By :-
Dr.Priyanka Sharma
1st year MDS
Dept. Of Public Health Dentistry
1
 CONTENTS
• Introduction

- Nutrition

- Carbohydrates

- Classification of carbohydrates

- Functions of carbohydrates

- What is metabolism?

• Major metabolic pathways of carbohydrates

- Introduction about each pathway

- Step of reactions in every metabolic pathway

- Clinical Aspects
2
• Polysaccharides and clinical aspects

• Role of hormones in carbohydrate metabolism

• Dental aspects of carbohydrate metabolism

• Recent issue related to carbohydrate metabolism

• Summary of carbohydrate metabolism

• Conclusion

• References

3
INTRODUCTION

4
 NUTRITION
• Nutrition is defined as “ the science of how the
body utilizes food to meet requirements for
development growth, repair and maintenance.”

CARBOHYDRATES

FATS

PROTEINS

VITAMINS

MINERALS

WATER
5
 Daily Intake
• Nutrient Quantity Per Day

 Energy = 8,700 kilojoules

 Protein = 50 grams

 Fat = 70 grams

 Carbohydrates = 310 grams

 Sugars = 90 grams

 Sodium (salt) = 2.3 grams

 Dietary Fibre = 30 grams

 Saturated Fatty Acids = 24 grams 6

 CARBOHYDRATE:
 Most abundant organic molecule on earth.
 Carbohydrates are defined as aldehyde or keto derivatives
of polyhydric alcohols.
 For example: Glycerol on oxidation is converted to
D-glyceraldehyde, which is a carbohydrate derived from the
trihydric alcohol (glycerol).
 All carbohydrates have the general formula CnH2nOn [or it
can be re-written as Cn(H2O)n ] .

7
 CLASSIFICATION OF
CARBOHYDRATE
Erythrose ,
Monosaccharides
Ribose,Glucose

Disaccharides Sucrose , lactose

CARBOHYDRATE

Oligosaccharides Maltotriose

Starch , cellulose,
Polysaccharides
dextrin , dextran

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FUNCTIONS OF CARBOHYDRATES

 Main source of energy in the body. Energy

production from carbohydrates will be 4 k
calories/g (16 k Joules/g).
 Storage form of energy (starch and glycogen).
 Excess carbohydrate is converted to fat.
 Glycoproteins and glycolipids are components of
cell membranes and receptors.
 Structural basis of many organisms. For example,
cellulose of plants,exoskeleton of insects etc.

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Biomedical Importance Of Glucose
• Glucose is a major carbohydrate
• It is a major fuel of tissues
• It is converted into other carbohydrates
 Glycogen for storage.
 Ribose in nucleic acids.
 Galactose in lactose of milk.
 They form glycoproteins & proteoglycans
 They are present in some lipoproteins (LDL) .
 Present in plasma membrane:glycocalyx.
 Glycophorin is a major intergral membrane glycoprotein
of human erythrocytes.

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 Metabolism
Thousands of chemical reactions are
taking place inside a cell in an
organized, well co-ordinated and
purposeful manner; all these
reactions are called as
METABOLISM.

TYPES OF METABOLIC
PATHWAY:
Catabolic Pathway
Anabolic Pathway
Amphibolic Pathway

STAGES AND PHASES

OF METABOLISM:
Primary
Secondary
Tertiary 11
Food molecules Simpler molecules

Amphibolic pathway

Anabolic Catabolic

Proteins, carbohydrates, CO2+H2O

lipids, nucleic acids etc.

12
Major Pathways
of
Carbohydrate
Metabolism

13
1) Glycolysis

2) Citric Acid Cycle

3) Gluconeogenesis

4) Glycogenesis

5) Glycogenolysis

6) Hexose monophosphate shunt

7) Uronic Acid Pathway

8) Galactose Metabolism

9) Fructose Metabolism

10) Amino sugar metabolism 14

 Entry of Glucose into cells
1) Insulin-independent transport system of glucose:
Not dependent on hormone insulin. This is operative
in – hepatocytes, erythrocytes (GLUT-1) and brain.
2) Insulin-dependent transport system: Muscles and
adipose tissue (GLUT-4).
Type 2 diabetes
melitus:
-Due to reduction
in the quantity of
GLUT-4 in insulin
deficiency.
-Insuin resistance
is observed in
tissues. 15
 Glycolysis
Embden-Meyerhof pathway
(or)
E.M.Pathway

Definition:
Glycolysis is defined as the sequence of
reactions converting glucose (or glycogen) to
pyruvate or lactate, with the production of ATP
16
 Salient features:
1) Takes place in all cells of the body.
2) Enzymes present in “cytosomal fraction” of the cell.
3) Lactate – end product – anaerobic condition.
4) Pyruvate(finally oxidized to CO2 & H2O) – end
product of aerobic condition.
5) Tissues lacking mitochondria – major pathway – ATP
synthesis.
6) Very essential for brain – dependent on glucose for
energy.
7) Central metabolic pathway
8) Reversal of glycolysis – results in gluconeogenesis.

17
 Reactions of Glycolysis

1) Energy Investment phase (or)

priming phase

2) Splitting phase

3) Energy generation phase

18
 • Glucose is phosphorylated to glucose-6-phosphate by hexokinase (or) glucokinase.

• Glucose-6-phosphate undergoes isomerization to give fructose -6- phosphate in the presense of

Energy phospho-hexose isomerase and Mg2+
Investment • Fructose-6-phosphate is phoshorylated to fructose 1,6-bisphosphate by phosphofructokinase.
Phase

• Fructose 1,6-bisphosphate  glyceraldehyde 3-phosphate + dihydroxyacetone

phosphate.(aldolase enzyme)
Splitting • 2 molecules of glyceraldehyde 3-phosphate are obtained from 1 molecule of glucose
Phase

• Glyceraldehyde 3-phosphate  1,3-bisphosphoglycerate(glyceraldehyde 3-phosphate hydrogenase )

• 1,3-bisphosphoglycerate  3-phosphoglycerate (phosphoglycerate kinase)

• 3-phosphoglycerate  2-phosphoglycerate (phosphoglycerate mutase)

Energy
Generation • 2-phosphoglycerate  phosphoenol pyruvate (enolase + Mg2+ & Mn2+)
Phase • Phosphoenol pyruvate  pyruvate [enol] (pyruvate kinase )  pyruvate [keto]  L-Lactate
(lactate dehydrogenase)
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20
21
 Energy production of glycolysis:
ATP production = ATP produced - ATP utilized
ATP produced ATP utilized Net energy

In absence of oxygen 4 ATP 2ATP 2 ATP

(anaerobic glycolysis) (Substrate level From glucose to glucose -
phosphorylation) 6-p.
From fructose -6-p to
2ATP from 1,3 DPG. fructose 1,6 p.

2ATP from phosphoenol

pyruvate

In presence of oxygen 4 ATP 2ATP 8 ATP /

(aerobic glycolysis) (substrate level -From glucose to glucose - 6 ATP (Pyruvate
phosphorylation) 6-p. dehydrogenase
2NADH,ETC,
2ATP from 1,3 BPG. From fructose -6-p to Oxidative
2ATP from phosphoenol fructose 1,6 p. phosphorylation)
pyruvate.

+ 4ATP or 6ATP
(from oxidation of 2
NADH + H in
mitochondria).
22
 CLINICAL ASPECT

1) Lactic acidosis
- Normal value – 4 to 15 mg/dl.
- Mild forms – strenous exercise, shock,
respiratory diseases, cancers
- Severe forms – Impairment/collapse of
circulatory system – myocardial infarction,
pulmonary embolism, uncontrolled
hemmorrhage and severe shock.

23
2) Cancer and glycolysis :

- Cancer cells – increased uptake of glucose and

glycolysis.

- Blood vessels unable to supply adequate oxygen –

HYPOXIC condition – Anaerobic glycolysis /
hypoxic glycolysis – Involvement of Hypoxic
inducible transcription factor (HIF).

- Treatment : Use drugs that inhibit vascularization

of tumours
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 Pasteur effect : Inhibition of glycolysis by
oxygen (Phosphofructokinase) .

 Crabtree effect : The phenomenon of

inhibition of oxygen consumption by the
addition of glucose to tissues having high
aerobic glycolysis.

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 RAPARPORT – LEUBERING CYCLE

• Supplementary pathway/ Shunt pathway to glycolysis .

• Erythrocytes

• Synthesis of 2,3-bisphosphoglycerate (2,3-BPG).

• Without the synthesis of ATP.

• Help to dissipate or waste the energy not needed by RBCs.

• Supply more oxygen to the tissues.

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CITRIC ACID CYCLE
KREBS CYCLE /
TRICARBOXYLIC ACID/ TCA
CYCLE

Essentially involves the oxidation of acetyl CoA

to CO2 and H2O.
This Cycle utilizes about two-third of total
oxygen consumed by the body.

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 Location of
Brief History: Overview
TCA
• Hans Adolf • Mitochondrial • 65-70% of the
Krebs matrix ATP is
synthesized
• 1937 • In close
proximity to • Name : TCA
• Studies of the electronic used because
oxygen transport at the ouset of
consumptiom chain. the cycle
in pigeon tricarboxylic
breast muscle. acids
participate.

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 Reactions of citric acid cycle
1) Formation of citrate : Condensation of acetyl CoA and
oxaloacetate  catalysed by citrate synthase.

2) & 3) Citrate is isomerized to isocitrate  aconitase (two

steps).

4) & 5) Formation of ᾀ-ketoglutarate : enzyme isocitrate

dehydrogenase.

6) Conversion of ᾀ-ketoglutarate to succinyl CoA :

through oxidative decarboxylation, catalysed by ᾀ-
ketoglutarate dehydrogenase complex. 29
7)Formation of succinate : enzyme succinate
thiokinase
GTP + ADP  ATP + GDP (nucleoside
diphosphate kinase)

8)Conversion of succinate to fumarase : enzyme

succinate dehydrogenase

9)Formation of malate : enzyme fumarase

10)Conversion of malate to oxaloacetate : enzyme

malate dehydrogenase.

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31
• TCA cycle is strictly aerobic in contrast to glycolysis.

• Total of 12 ATP are produced from one acetyl CoA :-

 During the process of oxidation of acetyl CoA via citric

acid cycle  3 NADH & 1 FADH2.

 Oxidation of 3 NADH by electron transport chain

coupled with oxidative phosphorylation results in 9
ATP, FADH2  2 ATP.

 One substrate level phosphorylation.

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 APPLIED
ASPECTS
OF Mitochondrial
TCA CYCLE encephalopathy
occurs due to
fumarase
deficiency .

It is a
mitochondrial
myopathy affecting
both the skeletal
muscles and brain .
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 GLUCONEOGENESIS
The synthesis of glucose from non-carbohydrate
compounds is known as gluconeogenesis.

Major substrate/precursors : lactate, pyruvate, glycogenic

amino acids, propionate & glycerol.

-Takes place in liver (1kg glucose) ; kidney matrix( 1/3rd).

- Occurs in cytosol and some produced in mitochondria.

34
Importance of Gluconeogenesis

Brain,CNS,
Under anaerobic
erythrocytes,testes condition, glucose
and kidney medulla is the only source
dependent on to supply skeletal
glucose for cont. muscles.
supply of energy.

Effectively
Occurs to meet the clears,certain
basal req of the metabolites
body for glucose produced in the
in fasting for even tissues that
more than a day. accumulates in
blood

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Reaction of Gluconeogenesis

Glucose

36
Cori Cycle

The cycle
involveing the
synthesis of
glucose in liver
from the skeletal
muscle lactate and
the reuse of
glucose thus
synthesized by the
muscle for energy
purpose is known
as Cori cycle.
37
Glucose-Alanine Cycle

38
 Clinical Aspects
* Glucagon stimulates gluconeogenesis:
1)Active pyruvate kinase converted to inactive form
2)Reduces the concentration of fructose 2,6-bisphosphate.

* Glycogenic amino acids have stimulating influence on gluconeogenesis.

* Diabetes mellitus where amino acids are mobilized from muscle protein for the
purpose of gluconeogenesis.

Acetyl CoA promotes gluconeogenesis:

* During starvation – due to excessive lipolysis in adipose tissue –acetyl CoA
accumulates in the liver.
* Acetyl CoA allosterically activates pyruvate carboxylase resulting in enhanced
glucose production

* Alcohol inhibits gluconeogenesis

39
 GLYCOGEN
METABOLISM
Glycogen is a storage form of glucose in animals.

Stored mostly in liver (6-8%) and muscle (1-2%)

Due to muscle mass the quantity of glycogen in muscle = 250g

and liver =75g

Stored as granules in the cytosol.

Functions : Liver glycogen – maintain the blood glucose level

Muscle glycogen – serves as fuel reserve

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 GLYCOGENESIS

 Synthesis of glycogen from glucose.

 Takes place in cytosol.

 Requires UTP and ATP besides glucose.

 Steps in synthesis :
1) Synthesis of UDP- glucose
2) Requirement of primer to initiate glycogenesis
3) Glycogen synthesis by glycogen synthase
4) Formation of branches in glycogen
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42
 GLYCOGENOLYSIS

 Degradation of stored glycogen in liver and muscle constitutes

glycogenolysis.

 Irreversible pathway takes place in cytosol.

 Hormonal effect on glycogen metabolism :

1) Elevated glucagon – increases glycogen degradation
2) Elevated insulin – increases glycogen synthesis

 Degraded by breaking majorly α-1,4- and α-1,6-glycosidic bonds.

 Steps in glycogenolysis:
1) Action of glycogen phosphorylase
2) Action of debranching enzyme
3) Formation of glucose-6-phosphate and glucose
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44
 Glycogen storage diseases
TYPE ENZYME DEFECT CLINICAL FEATURES
Type I (Von Gierke’s Glucose-6- Hypoglycemia, enlarged liver and kidneys,
disease) phosphatase gastro-intestinal symptoms, Nose bleed, short
deficiency. stature, gout

Type II (Pompe’s Acid maltase Diminished muscle tone, heart failure, enlarged
disease) deficiency tongue

Type III (Cori’s Debranching enzyme Hypoglycemia, enlarged liver, cirrhosis, muscle
disease,Forbe disease) deficiency weakness, cardiac involvement

Type IV (Andersen’s Branching enzyme Enlarged liver & spleen, cirrhosis, diminished
disease) deficiency muscle tone, possible nervous system
involvement

Type V (Mcardle’s Muscle phosphorylase Muscle weakness, fatigue and muscle cramps
disease) deficiency
45
 TYPE ENZYME DEFECT CLINICAL FEATURES

Type VI (Her’s Liver phosphorylase Mild hypoglycemia, enlarged liver, short

disease) deficiency stature in childhood

Type VII (Tarui’s Phosphofructokinase Muscle pain, weakness and decreased

disease) deficiency endurance

Type VIII Liver phosphorylase Mild hypoglycemia, enlarged liver, short

kinase stature in childhood, possible muscle weakness
and cramps

Type 0 Liver glycogen Hypoglycemia, possible liver enlargement

synthetase

46
Von Gierke’s disease)

Pompe’s disease

47
Cori’s disease, Forbe
disease

48
HEXOSE MONOPHOSPHATE
SHUNT

HMP Shunt/ Pentose Phosphate Pathway/

Phosphogluconate Pathway

49
* This is an alternative pathway to glycolysis and TCA cycle
for the oxidation of glucose.

* Anabolic in nature, since it is concerned with the

biosynthesis of NADPH and pentoses.

* Unique multifunctional pathway

* Enzymes located – cytosol

* Tissues active – liver, adipose tissue, adrenal gland,
erythrocytes, testes and lactating mammary gland. 50
Reactions of the HMP Shunt Pathway

51
 Significance of HMP Shunt
• Pentose or its derivatives are useful for the
synthesis of nucleic acids and nucleotides.

• NADPH is required :
- For reductive biosynthesis of fatty acids and
steroids.
- For the synthesis of certain amino acids.
- Anti-oxidant reaction
- Hydroxylation reaction– detoxification of drugs.
- Phagocytosis
- Preserve the integrity of RBC membrane. 52
 Clinical Aspects
• Glucose-6-Phosphate dehydrogenase
deficiency :
- Inherited sex-linked trait
- Red blood cells
- Impaired synthesis of NADPH
- hemolysis , developing hemolytic anemia
 Resistance towards malaria [Africans]

53
 Clinical Aspects
• Wernicke-Korsakoff syndrome :
- Genetic disorder
- Alteration in transketolase activity
- Symptoms : mental disorder, loss of memory,
partial paralysis

• Pernicious anemia : transketolase activity

increases.
54
URONIC ACID PATHWAY
(Or)
Glucoronic acis pathway

55
 Alternative oxidative pathway for glucose.

 synthesis of glucorinc acid,pentoses and vitamin

(ascorbic acid).

 Normal carbohydrate metabolism ,phosphate

esters are involved – but in uronic acid pathway
free sugars and sugar acids are involved.

 Steps of reactions :
1) Formation of UDP-glucoronate
2) Conversion of UDP- glucoronate to L-gulonate
3) Synthesis of ascorbic acid in some animals
4) Oxidation of L-gulonate
56
57
 Clinical Aspects

• Effects of drugs : increases the pathway to achieve

more synthesis of glucaronate from glucose .
- barbital,chloro-butanol etc.

• Essential pentosuria : deficiency of xylitol-

dehydrogenase
- Rare genetic disorder
- Asymptomatic
- Excrete large amount of L-xylulose in urine
- No ill-effects
58
METABOLISM OF
GALACTOSE

59
 Disaccharide lactose present in milk – principle source of of galactose.

 Lactase of intestinal mucosal cells hydrolyses lactose to galactose and glucose.

 Within cell galactose is produced by lysosomal degradation of glycoproteins

and glycolipids.

 CLINICAL ASPECTS :

- Classical galactosemia : deficiency of galactose-1-phosphate

uridyltransferase. Increase in galactose level.

- Galactokinase deficiency : Responsible for galactosemia and galactosuria.

- Clinical symptoms : loss of weight in infants, hepatosplenomegaly, jaundice,

mental retardation , cataract etc.

- Treatment : removal of galactose and lactose from diet.

60
 METABOLISM OF
FRUCTOSE
Sorbitol/Polyol Pathway:
 Conversion of glucose to fructose via sorbitol.

 Glucose to Sorbitol reduction by enzyme aldolase (NADPH).

 Sorbitol is then oxidized to fructose by sorbitol dehydrogenase and

NAD+.

 Fructose is preferred carbohydrate for energy needs of sperm cells

due to the presence of sorbitol pathway.

Pathway is absent in liver.

Directly related to glucose : higher in uncontrolled diabetes.

61
 METABOLISM OF AMINO
SUGARS
When the hydroxyl group of the sugar is replaced by the amino
group, the resultant compound is an amino sugar.

Eg. Glucosamine,galactosamine,mannosamine,sialic acid etc.

Essential components of glycoproteins, glycosaminoglycans,

glycolipids.

Found in some antibiotics.

20% of glucose utilized for the synthesis of amino sugars –

connective tissues.

62
 Electron transport chain
reactions
• Electron transport chain is a series of protein
complexes located in the inner membrane of
mitochondria .

63
POLYSACCHARIDES
&
CLINICAL ASPECTS

64
Proteoglycans & Glycosaminoglycans
 Seven glycosaminoglycans :

1 ) Hyaluronic acid
2 ) Chondriotin sulfate
3 ) Keratan sulfate I
4 ) Keratan sulfate II
5 ) Heparin
6 ) Heparan sulfate
7 ) Dermatan sulfate
65
 Functions of glycoaminoglycans
• Structural components of extracellular matrix.
• Act as sieves in extracellular matrix.
• Facilitate cell migration.
• Corneal transparency.
• Anticoagulant (Heparin).
• Components of synaptic & other vesicles.

66
 Mucopolysaccharidoses
MPS Defect Symptoms

MPS I (Hurler Alpha-L-Iduronidase Mental retardation, micrognathia, coarse facial

syndrome) features, macroglossia, retinal degeneration,
corneal clouding, cardiomyopathy,
hepatosplenomegaly

MPS II (Hunter Iduronate sulfatase Mental retardation (similar, but milder,

syndrome) symptoms to MPS I). This type exceptionally
has X-linked recessive inheritance

MPS IIIA Heparan sulfate N

(Sanfilippo A) sulfatase

MPS IIIB Alpha- Developmental delay, severe hyperactivity,

(Sanfilippo B) Acetylglucosaminidase spasticity, motor dysfunction, death by the
second decade
MPS IIIC Acetyl transferase
(Sanfilippo C)
67
 MPS Defect Symptoms

MPS IVA Galactose-6-sulfatase

(Morquio A)
Severe skeletal dysplasia, short stature, motor
MPS IVB (Morquio Beta galactosidase dysfunction
B)

MPS VI N acetylgalactosamine 4 Severe skeletal dysplasia, short stature, motor

(Maroteaux Lamy sulfatase dysfunction, kyphosis, heart defects
syndrome)

MPS VII (Sly) Beta glucoronidase Hepatomegaly, skeletal dysplasia, short

stature, corneal clouding, developmental delay

MPS IX (Natowicz Hyaluronidase deficiency Nodular soft-tissue masses around joints,

syndrome) episodes of painful swelling of the masses,
short-term pain, mild facial changes, short
stature, normal joint movement, normal
intelligence 68
Hunter’s syndrome

• Short and broad mandible

• Localized radiolucent
lesions of the jaw
• Flattened
temporomandibular joints
• Macroglossia
• Conical peg-shaped teeth
with generalized wide spacing
• Highly arched palated with
flattened alveolar ridges
• Hyperplastic gingiva

69
ROLE OF HORMONES IN
CARBOHYDRATE
METABOLISM

70
 Regulation of Blood glucose
• Postabsorptive state: Blood glucose is 4.5-
5.5mmol/L.

• After carbohydrate meal: 6.5-7.2mmol/L

• During fasting : 3.3-3.9mmol/L

71
 Metabolic & hormonal mechanisms
regulate blood glucose level
Maintenance of stable levels of glucose in blood is by
 Liver.
 Extrahepatic tissues.
 Hormones .

72
Regulation of blood glucose levels
Insulin

73
Role of glucagon

74
 Role of thyroid hormone
 It stimulates glycogenolysis & gluconeogenesis.
Hypothyroid Hyperthyroid
 Fasting blood glucose
is lowered. Fasting blood
 Patients have
glucose is elevated
decreased ability to Patients utilise
utilise glucose. glucose at normal or
 Patients are less increased rate
sensitive to insulin
than normal or
hyperthyroid patients.
75
 Glucocorticoids
 Glucocorticoids are antagonistic to insulin.

 Inhibit the utilisation of glucose in extrahepatic

tissues.

 Increased gluconeogenesis .

76
 Epinephrine
 Secreted by adrenal medulla.

 It stimulates glycogenolysis in liver & muscle.

 It diminishes the release of insulin from pancreas.

77
 Other Hormones
 Anterior pituitary hormones
Growth hormone:
 Elevates blood glucose level & antagonizes action of
insulin.
 Growth hormone is stimulated by hypoglycemia
(decreases glucose uptake in tissues)
 Chronic administration of growth hormone leads to
diabetes due to B cell exhaustion.
78
 SEX HORMONES

Estrogens cause increased liberation of

insulin.

Testosterone decrease blood sugar level.

79
 Hyperglycemia Hypoglycemia

 Thirst, dry mouth  Sweating

 Polyuria  Trembling,pounding
 Tiredness, fatigue heart
 Blurring of vision.  Anxiety, hunger
 Nausea, headache,  Confusion, drowsiness
 Hyperphagia  Speech difficulty
 Mood change  Incoordination.
 Inability to concentrate

80
 Clinical aspects
 Glycosuria: occurs when venous blood
glucose concentration exceeds
9.5-10.0mmol/L

 Fructose-1,6-Biphosphatase deficiency causes

lactic acidosis & hypoglycemia..
81
 Diabetes Mellitus
A multi-organ catabolic response caused by insulin insufficiency

Muscle

– Protein catabolism for gluconeogenesis

Adipose tissue

– Lipolysis for fatty acid release

Liver

– Ketogenesis from fatty acid oxidation

– Gluconeogenesis from amino acids and glycerol

Kidney

– Ketonuria and cation excretion

82
– Renal ammoniagenesis.
DENTAL ASPECTS OF
CARBOHYDRATES
METABOLISM

83
 Role of carbohydrates in dental caries
• Fermentable carbohydrates causes loss of
caries resistance.
• Caries process is an interplay between oral
bacteria, local carbohydrates & tooth surface

Bacteria + Sugars+ Teeth Organic acids

Caries
84
 Role of carbohydrates in periodontal
disease
Abnormal Excessive carbohydrate
glucose metabolism intake

Diabetes Mellitus Obesity

Periodontal disease Periodontal disease

85
RECENT CLINICAL ISSUES
RELATED TO
CARBOHYDRATES
METABOLISM

86
 Cystic Fibrosis
• CMD in Cystic Fibrosis is characterized by its high
rates and latent course.
• The patients with CMD have retarded physical
development, more pronounced morphofunctional
disorders in the bronchopulmonary system, lower lung
functional parameters, and more aggressive sputum
microbial composition. (Samoĭlenko VA et al.)

87
 CMD in Gout
• OGTT causes a 34% increase in the detection rate of
T2D in patients with gout.

• Carbohydrate metabolic disturbances are revealed in

the majority of patients with gout and associated with
obesity, hypertriglyceridemia, high serum UA levels,
chronic disease forms, the high incidence of CHD and
arterial hypertension.(Eliseev MS et al.)
88
SUMMARY OF CARBOHYDRATE
METABOLISM

89
 PER DAY INTAKE OF
CARBOHYDRATE
• Carbohydrate Calculator
http://www.calculator.net/carbohydrate-
calculator.html?ctype=metric&cage=25&csex
=f&cheightfeet=5&cheightinch=10&cpound=
160&cheightmeter=163&ckg=74&cactivity=1.
375&x=85&y=10#

90
 CONCLUSION
• Carbohydrate are the measure source of energy
for the living cells. Glucose is the central
molecule in carbohydrate metabolism, actively
participating in a number of metabolic
pathway.
• One component of etiology of dental caries is
carbohydrate which act as substrate for
bacteria. Every effort should be made to
reduce sugar intake for healthy tooth.
91
 REFERENCES
1) Biochemistry – U.Satyanarayana-3rd Ed.
2) Textbook of Biochemistry- D.M.Vasudevan -14th
Ed.
3) Textbook of Medical Biochemistry –
M.N.Chattergy – 17th Ed.
4) Text book of Physiology –Ganong – 24th Ed.
5) Text book of Oral Pathology – Shafers- 7th Ed.
6) Principles & practice of Medicine-Davidson –
21st Ed.
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