Carbohydrate Metabolism

Carbohydrate metabolism begins with digestion in the small intestine where monosaccharides are absorbed into the blood stream. Blood sugar concentrations are controlled by three hormones: insulin, glucagon, and epinephrine. If the concentration of glucose in the blood is too high, insulin is secreted by the pancreas. Insulin stimulates the transfer of glucose into the cells, especially in the liver and muscles, although other organs are also able to metabolize glucose. In the liver and muscles, most of the glucose is changed into glycogen by the process of glycogenesis(anabolism). Glycogen is stored in the liver and muscles until needed at some later time when glucose levels are low. If blood glucose levels are low, then eqinephrine and glucogon hormones are secreted to stimulate the conversion of glycogen to glucose. This process is called glycogenolysis (catabolism). If glucose is needed immediately upon entering the cells to supply energy, it begins the metabolic process called glycoysis (catabolism). The end products of glycolysis are pyruvic acid and ATP. Since glycolysis releases relatively little ATP, further reactions continue to convert pyruvic acid to acetyl CoA and then citric acid in the citric acid cycle. The majority of the ATP is made from oxidations in the citric acid cycle in connection with the electron transport chain. During strenuous muscular activity, pyruvic acid is converted into lactic acid rather thatn acetyl CoA. Durlng the resting period, the lactic acid is converted back to pyruvic acid. The pyruvic acid in turn is converted back to glucose by the process called gluconeogenesis (anabolism). If the glucose is not needed at that moment, it is converted into glycogen by glycogenesis. You can remember those terms if you think of "genesis" as the formation-beginning. These processes are summarized in the Metaboism Summary in the graphic on the left. Each of these processes will be developed in greater detail various pages of this module. http://www.elmhurst.edu/~chm/vchembook/600glycolysis.html

Diabetes Melitus dan Gout Arthritis

Diabetes mellitus (or diabetes) is a chronic, lifelong condition that affects your body's ability to use the energy found in food. There are three major types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.

All types of diabetes mellitus have something in common. Normally, your body breaks down the sugars and carbohydrates you eat into a special sugar called glucose. Glucose fuels the cells in your body. But the cells need insulin, a hormone, in your bloodstream in order to take in the glucose and use it for energy. With diabetes mellitus, either your body doesn't make enough insulin, it can't use the insulin it does produce, or a combination of both.

Since the cells can't take in the glucose, it builds up in your blood. High levels of blood glucose can damage the tiny blood vessels in your kidneys, heart, eyes, or nervous system. That's why diabetes -- especially if left untreated -- can eventually cause heart disease, stroke, kidney disease, blindness, and nerve damage to nerves in the feet.

Type 1 Diabetes

Type 1 diabetes is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it often begins in childhood.

Type 1 diabetes is an autoimmune condition. It's caused by the body attacking its own pancreas with antibodies. In people with type 1 diabetes, the damaged pancreas doesn't make insulin.

This type of diabetes may be caused by a genetic predisposition. It could also be the result of faulty beta cells in the pancreas that normally produce insulin.

A number of medical risks are associated with type 1 diabetes. Many of them stem from damage to the tiny blood vessels in your eyes (called diabetic retinopathy), nerves (diabetic neuropathy), and kidneys (diabetic nephropathy). Even more serious is the increased risk of heart disease and stroke.

Treatment for type 1 diabetes involves taking insulin, which needs to be injected through the skin into the fatty tissue below. The methods of injecting insulin include:

·         Syringes

·         Insulin pens that use pre-filled cartridges and a fine needle

·         Jet injectors that use high pressure air to send a spray of insulin through the skin

·         Insulin pumps that dispense insulin through flexible tubing to a catheter under the skin of the abdomen

Type 2 diabetes, once called non-insulin-dependent diabetes, is the most common form of diabetes, affecting 90% to 95% of the 26 million Americans with diabetes. 

What Is Type 2 Diabetes?

Unlike people with type 1 diabetes, the bodies of people with type 2 diabetes make insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. This is calledinsulin resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are not able to function properly. Other problems associated with the buildup of glucose in the blood include:

·         Damage to the body. Over time, the high glucose levels in the blood can damage the nerves and small blood vessels of the eyes, kidneys, and heart and lead to atherosclerosis, or hardening of the arteries that can cause heart attack and stroke.

·         Dehydration. The buildup of sugar in the blood can cause an increase in urination, causing dehydration.

·         Diabetic coma (hyperosmolar nonketotic diabetic coma). When a person with type 2 diabetes becomes very ill or severely dehydrated and is not able to drink enough fluids to make up for the fluid losses, they may develop this life-threatening complication.

Type 2 Diabetes in Children

More and more children are being diagnosed with type 2 diabetes. Find out about type 2 diabetes symptoms in children, the diagnosis, and the treatment of type 2 diabetes in childhood. If your child is at risk for childhood diabetes, it’s important to learn specific self-care tips to help prevent diabetes.

For more detail, see Type 2 Diabetes in Children.

Who Gets Type 2 Diabetes?

Anyone can get type 2 diabetes. But those at highest risk for the disease are those who:

·         Are over 45

·         Are obese or overweight

·         Have had gestational diabetes 

·         Have family members who have type 2 diabetes

·         Have prediabetes

·         Don't exercise

·         Have low HDL cholesterol or high triglycerides

·         Have high blood pressure

·         Are members of certain racial or ethnic groups including:

·         African Americans

·         Latinos

·         Native Americans

·         Asian Americans/Pacific Islanders

Gestational diabetes is a condition characterized by high blood sugar (glucose) levels that is first recognized during pregnancy. The condition occurs in approximately 4% of all pregnancies.

What Causes Gestational Diabetes in Pregnancy?

Almost all women have some degree of impaired glucose intolerance as a result of hormonal changes that occur during pregnancy. That means that their blood sugar may be higher than normal, but not high enough to have diabetes. During the later part of pregnancy (the third trimester), these hormonal changes place pregnant woman at risk for gestational diabetes.

During pregnancy, increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus) help shift nutrients from the mother to the developing fetus. Other hormones are produced by the placenta to help prevent the mother from developing low blood sugar. They work by resisting the actions of insulin.

Over the course of the pregnancy, these hormones lead to progressive impaired glucose intolerance (higher blood sugar levels). To try to decrease blood sugar levels, the body makes more insulin to get glucose into cells to be used for energy.

Usually, the mother's pancreas is able to produce more insulin (about three times the normal amount) to overcome the effect of the pregnancy hormones on blood sugar levels. If, however, the pancreas cannot produce enough insulin, blood sugar levels will rise, resulting in gestational diabetes.

What Are the Complications of Gestational Diabetes?

Diabetes can affect the developing fetus throughout the pregnancy. In early pregnancy, a mother's diabetes can result in birth defects and an increased rate of miscarriage. Many of the birth defects that occur affect major organs such as the brain and heart.

During the second and third trimester, a mother's diabetes can lead to over-nutrition and excess growth of the baby. Having a large baby increases risks during labor and delivery. For example, large babies often require planned or emergency caesarean deliveries, and if he or she is delivered vaginally, they are at increased risk for complications such as trauma to the baby.

In addition, when high blood sugar from the mother causes high insulin levels (hyperinsulinemia) in the baby, the baby's blood sugar can drop very low after birth, because it won't be receiving the high blood sugar.

However, with proper treatment, you can deliver a healthy baby, despite having diabetes.

GOUT ARTHRIS

Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe. These attacks can happen over and over unless gout is treated. Over time, they can harm your joints, tendons, and other tissues. Gout is most common in men.

Gout is caused by too much uric acid in the blood. Most of the time, having too much uric acid isn't harmful. Many people with high levels in their blood never get gout. But when uric acid levels in your blood are too high, the uric acid may form hard crystals in your joints.

Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines. Some medicines, such as water pills (diuretics), can also bring on gout.

The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in your big toe. You can also get gout attacks in your foot, ankle, or knees, or other joints. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years.

See your doctor even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints.

Your doctor will ask questions about your symptoms and do a physical exam. Your doctor may also take a sample of fluid from your joint to look for uric acid crystals. This is the best way to test for gout. Your doctor may also do a blood test to measure the amount of uric acid in your blood.

To stop a gout attack, your doctor can give you a shot of corticosteroids or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.

Gout - Cause

Gout Guide

Gout is caused by too much uric acid in the blood (hyperuricemia). The exact cause of hyperuricemia sometimes isn't known, although inherited factors (genes) seem to play a role.

Uric acid may form crystals that build up in the joints. This causes the pain and other symptoms.

Gout can seem to flare up without specific cause. Or it can be brought on by:

·         Certain conditions related to dietand body weight, such as being overweight, eating a diet rich in meat and seafood (high-purine foods), and drinking too much alcohol.

·         Medicines that may increase uric acid concentration, such as regular use of aspirin or niacin or using medicines that reduce the amount of salt and water in the body (diuretics).

·         Major illness or certain medical conditions, such as rapid weight lossor high blood pressure.

·         Surgery.

·         Having been born with a rare condition that causes high blood uric acid levels. People with Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome have a partial or complete deficiency in an enzyme that helps to control uric acid levels.

Gout - What Happens

Gout Guide

·          

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissues. A gout attack usually starts during the night with moderate pain that grows worse. A gout attack typically causes pain, swelling, redness, and warmth (inflammation) in a single joint, most often the big toe. Then symptoms gradually go away.

·         Most gout attacks stop after about a week.

·         Mild attacks may stop after several hours or last for 1 to 2 days. These attacks are often misdiagnosed as tendinitis or a sprain.

·         Severe attacks may last up to several weeks, with soreness lasting for up to 1 month.

·         Many people have a second attack of gout within 6 months to 2 years after their first attack. But there may be intervals of many years between attacks. If gout is untreated, the frequency of attacks usually increases with time.

There are three stages of gout.¹ Many people never experience the third stage.

·         In the first stage, you have high uric acid levels in your blood, but no symptoms. The uric acid levels may stay the same, and you may never have symptoms. Some people may have kidney stones before having their first attack of gout.

·         In the second stage, uric acid crystals begin to form, usually in the big toe. You begin to have gout attacks. After an attack, the affected joint feels normal. The time between attacks may grow shorter. Your later attacks may be more severe, last longer, and involve more than one joint.

·         In the third stage, symptoms may never go away. They may affect more than one joint. Gritty nodules called tophi may form under your skin.

·         Without treatment, the tophi may form in the cartilage of the external ear or the tissues around the joint (bursae, ligaments, and tendons). This can cause pain, swelling, redness, and warmth (inflammation). Progressive crippling and destruction of cartilage and bone is possible.

·         This stage of gout is uncommon because of advances in the early treatment of gout.

Gout - Symptoms

Gout Guide

Symptoms of gout include:

·         Warmth, pain, swelling, and extreme tenderness in a joint, usually a big toe joint . This symptom is called podagra. The pain often starts during the night. It may get worse quickly, last for hours, and be so intense that even light pressure from a sheet is intolerable.

·         Very red or purplish skin around the affected joint. The joint may appear to be infected.

·         Limited movement in the affected joint.

·         Peeling and itching of the skin around the affected joint as the gout gets better.

How symptoms vary

How, where, and when the symptoms of gout appear vary.

·         Some people may not experience gout as many painful attacks. Instead they have gout nearly all the time (chronic gout). Chronic gout in older adults may be less painful and can be confused with other forms ofarthritis.

·         Gout may lead to inflammation of the fluid sacs (bursae) that cushion tissues, particularly in the elbow (olecranon bursitis) and knee (prepatellar bursitis).

·         Gout can also affect the joints of the feet, ankles, knees, wrists, fingers, and elbows.

·         Symptoms may occur after an illness or surgery.

·         Gout may first appear as nodules (tophi) on the hands, elbows, or ears. You may not have any of the classic symptoms of a gout attack.

There are many other conditions with symptoms similar to gout

http://www.webmd.com/

Lagenda Bunga Mawar

 

Pernahkah Anda membayangkan mengapa bunga mawar itu begitu cantik dan indah tetapi kalau kita memegangnya, perih rasanya?

Di karangan ini Saya akan menceritakan satu kisah mengenai bunga mawar.

Zaman dahulu, seorang Ratu yang tercantik di seluruh dunia tinggal di sebuah istana yang indah sekali. Kecantikan Ratu itu memang luar biasa. Rambut dia seperti sutera yang bermutu tinggi, sepasang mata yang lebih indah daripada rubi dan kulitnya lebih halus dan putih daripada susu. Memang semua Raja di seluruh dunia ingin menikah dengannya tetapi dia begitu sombong sehingga dia menganggap semua Raja itu tidak cukup bagus untuknya. Kalau seorang Raja mengunjunginya di istana, pintu pun tidak dibukakan.

Nama Ratu adalah Mawar, jadi orang orang memanggilnya ratu Mawar. Ratu Mawar itu aneh orangnya karena dia paling benci kepada apa saja yang kelihatan jelek dan tidak cantik. Dia pikir barang – barang yang kelihatan jelek dan kotor harus dibuang dan orang orang yang kelihatan tidak cantik atau tidak tampan harus dibunuh

Penduduk di negera Ratu Mawar hidup susah. Orang orang di negara itu memang kasihan sekali karena uang yang mereka dapat harus dipakai untuk mendekorasi rumah dan sekitarnya. Kalau Ratu melihat tempat itu tidak cukup indah, mereka akan dihukum berat.

Suatu hari, waktu Ratu Mawar bersantai di kebun, dia melihat seorang yang kelihatan jelek dan kotor sekali. Orang itu tidak bisa berdiri seperti orang biasa karena bongkok.

Ratu Mawar tidak pernah melihat orang yang begitu jelek! Dia tidak bisa membayangkan tinggal di satu negera yang sama dengan orang seperti itu. Ratu Mawar memutuskan untuk membunuhnya. Dia menyuruh pegawainya untuk membunuh orang itu. Kekejaman Ratu Mawar memang luar biasa

Malam itu Ratu bermimpi. Dalam mimpinya dia bertemu dengan Tuhan yang Mahakuasa.

Tuhan bertanya kepada Ratu, “Apakah kamu tahu kesalahanmu?”

Ratu menjawab, “Tuhan yang Mahakuasa, apa maksud Anda? Apa yang sudah saya perbuat sehingga membuat Tuhan begitu marah?”

Tuhan berkata. “Jangan coba membohongi saya! Kamu sendiri tahu paling jelas kesalahanmu itu! Wajahmu begitu indah tetapi hatimu hitam dan penuh dengan kekotoran! Kamu akan dihukum! Saya akan membuat Kamu menjadi setangkai bunga. Seperti wajahmu bunga itu akan cantik sekali tapi tidak ada yang ingin menyentuhnya karena tangkaimu penuh dengan duri – duri yang membuat semua takut! Kamu akan hidup dalam kesepian selama lamanya!”

Matahari terbit dan pembantunya datang untuk membangunkan Ratu Mawar. Dia mengetok pintu beberapa kali tetapi sedikit suara pun tidak terdengar. Dia terpaksa masuk dan satu _ satunya yang dia lihat adalah setangkai bunga yang belum pernah dia lihat tetapi keindahannya luar biasa. Dia menamakan bunga itu ‘Mawar’.