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gihep 16: dietary states + metabolic processes (diabetes mellitus…
gihep 16: dietary states + metabolic processes
fed state
liver
more glycogenesis, hexose monophosphate pathway, glycolysis, protein synthesis, FA/TG synthesis
less gluconeogenesis
AAs degraded to pyruvate, ACoA to be used by other tissues
adipose tissue
more glucose transported here
more glycolysis, hexose monophosphate path, FA/TG synthesis
resting skeletal muscle
more glucose transported here
more glycogenesis, protein synthesis
increased uptake of branched AAs
muscle contains transaminase, needed to degrade them
FAs NOT important in skeletal muscle
brain
NO GLYCOGEN STORES
glucose exclusively used
levels must be > 30mg/100ml
normal level = 70-90 mg/100ml
NO TG STORES
FAs can't cross BBB
fasting state
liver
more glycogenolysis (lasts 10-18 hrs)
when glycogen depleted, more gluconeogenesis
maintains blood glucose overnight
more B-oxidation of FAs
more ketogenesis
KBs not used by liver, appear in blood by day 2 fast
used by other tissues for energy (spares protein degradation)
adipose tissue
less insulin, less glucose uptake
less FA/TG synthesis
more TG breakdown + FA release
resting skeletal muscle
less insulin, less glucose uptake
wk1-2: FAs + KBs used as fuel
wk 3: FAs used mostly
more proteolysis - provides AAs for gluconeogenesis
becomes less rapid when brain starts using KBs
brain
only glucose used for first few days
then KBs
regulation of insulin vs glucagon
glucose stimulates insulin, inhibits glucagon
AAs stimulate insulin + glucagon
adrenaline stimulates glucagon, inhibits insulin
increases cAMP + PKA causing phosphorylation
increases glycogen phosphorylase activity
decreases glycogen synthase activity
TAG -> hormone sensitive lipase -> 2,3 DAG + FA -> other lipases -> glycerol + 2FAs
inhibited by insulin
stimulated by absence of insulin
diabetes mellitus
fasting glucose > 7 mol/L
borderline cases confirmed by glucose tolerance test (over 2 hrs)
random glucose > 11.1 mol/L
90% = type 2
decreased clearance of lipoproteins (hypertriglyceridaemia)
ketoacidosis
weakness, kussmaul breathing, dehydration, nausea, vomiting, ab pain, mental confusion, coma, glycosuria
treatment: restore electrolytes, fluids, pH, glucose, admin insulin