Endocrinology: Control of Metabolism Flashcards

1
Q

Describe the action of insulin on metabolism in the liver, muscle and adipose tissue

A
  • Water-soluble hormone: binds to extracellular tyrosine kinase receptors on the cell membrane
  • Binding creates a cascade of events (signal amplification), that causes numerous phosphorylation events
  • Recruitment/ translocation of insulin-dependent transporters that fuse with cell membrane (GLUT-4) from cytoplasm to the cell membrane in adipocytes and myocytes
  • Glucose channels open, allowing glucose to enter the cell
  • Insulin promotes uptake of glucose into muscle and adipose
  • Insulin promotes fat and glycogen synthesis in the liver from acetyl-CoA
  • Fat is sent to adipose tissue for storage
  • Insulin secretion decreases during fasting
  • Cellular responses lead to anabolic pathways activated (glycogen and fat synthesis), catabolic pathways inactivated (beta oxidation of fats, glycolysis)
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2
Q

Describe the action of glucagon on metabolism in the liver

A
  • Glucagon stimulates liver to break down glycogen into its glucose subunits, through glycogenolysis
  • Increases blood glucose levels, which goes through glycolysis into pyruvate, and then into acetyl-coA, which enters the Kreb’s cycle
  • Glucagon promotes gluconeogenesis: synthesis of glucose from non-carbohydrate sources, e.g., amino acids (i.e., for the brain, needs glucose as an energy source)
  • Promotes ketogenesis; fatty acids converted into ketone bodies, which act as an additional fuel source, for the brain, when glucose is limited
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3
Q

Describe the action of glucagon on metabolism in muscles

A
  • Minimal direct effect
  • Increase in blood glucose provides source of energy for muscle
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4
Q

Describe the action of glucagon on metabolism in adipose tissue

A
  • Glucagon stimulates lipolysis = breakdown of triglycerides into glycerol and free fatty acids
  • Fatty acids can be used as an alternative energy source (by muscles, not brain) when glucose levels are low
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5
Q

How can metabolic pathways in a cell be controlled?

A
  • Pathways in the cytosol can be controlled by:
    o Substrate (food) availability)
    o Hormones
    o Enzyme control
     Covalent modification
     Allosteric modification
  • At a gene level by inducing/ repressing:
    o Transcription
    o Translation
    o Degradation
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6
Q

What happens in metabolic pathways is not controlled in a cell?

A

Metabolic mayhem

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7
Q

What is reversible covalent modification? How does it control enzyme activity?

A
  • Formation of a covalent bond
  • For example, phosphorylase is the enzyme that assists in the breakdown of glycogen to its glucose subunits
  • Phosphorylase B (less active) is converted to phosphorylase A (active) through addition of a phosphate group
  • Covalent modification does not control the LEVEL of enzyme activity; simply on or off
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8
Q

What is allosteric modification? How does it control enzyme activity?

A
  • Allosteric activators or deactivators
  • Activators turn enzymes on; bind to the allosteric binding site, and cause a conformational change in the active site of the enzyme, allowing substrates to be able to bind
  • Deactivators turn enzymes off; bind to the allosteric site, causing a conformational change in the active site, meaning the substrate is no longer complementary and cannot bind
  • Enzymes can be turned on/ off ‘to a certain degree’: control the LEVEL of enzyme activity
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9
Q

What is the energy source for the brain at 5 and 400 hours after not eating?

A

5 hours
- Glycogen from liver stores, via glycogenolysis (primary)
- Glucose from non-carbohydrate sources (amino acids), via gluconeogenesis
400 hours
- Glycogen stores depleted
- Gluconeogenesis can only provide a limited amount of glucose
- Primary energy source for the brain is ketone bodies; produced through ketogenesis in the liver (from fatty acids derived from adipose tissue triglycerides)

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10
Q

What are ketone bodies and why are they produced?

A

Ketone bodies are an alternative fuel source for the brain. They are produced in periods of fasting, as they are able to cross the blood-brain barrier to be used by the brain during periods where glucose is scarce, to enable function and survival.

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11
Q

Difference between water and fat soluble hormones

A
  • Water soluble hormones cannot pass through the cell membrane (hydrophobic) and must first bind to a signal receptor in the membrane (e.g., insulin and glucagon). This activates a whole cascade
  • Fat soluble hormones are hydrophobic and pass through the cell membrane and then bind to a signal receptor within the cytoplasm. Signals are amplified so not a lot of hormones need to enter cells
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12
Q

Action of insulin in terms of glucose uptake into myocytes/ adipose tissue

A
  • Insulin binds to surface receptors, initiating cascade of intracellular signalling events
  • Results in translocation of glucose transporter proteins (e.g., GLUT4) from intracellular storage vesicles to the cell membrane
  • Embeds into the cell membrane and facilitates uptake of glucose into myocytes and adipose tissue from the bloodstream
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13
Q

What controls the release of glucagon in the pancreas?

A
  • Low blood glucose levels trigger glucagon production and secretion from pancreatic alpha islet cells
  • Amino acids can also stimulate glucagon release
  • Adrenalin and noradrenaline can also stimulate release (sympathetic nervous system control)
  • Hormonal regulation: insulin (from beta cells in pancreas) and somatostatin (from gamma cells in pancreas) inhibits glucagon secretion
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14
Q

What are the different types of diabetes mellitus?

A

Diabetes melltius: with sugar
- Type 1: lack of insulin
- Type 2: diminished effectiveness of insulin (insulin resistance – doesn’t have the same amplification effects when it binds to surface receptors)
- Type 2 is increasing in community: accounts for 85-90% diabetic cases, increase thought to be due to lifestyle (obesity, inactivity)
- Impact: 40% tissues have insulin dependent transporters

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15
Q

What is diabetes insipidus?

A

Diabetes insipidus: sugar free (decreased levels of anti-diuretic hormone
- Other types: gestational, congenital

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16
Q

Type 1 diabetes mellitus

A

Type 1 Diabetes Mellitus (T1DM)
- Juvenile onset
- Moderate genetic predisposition
- Destruction of pancreatic beta cells

17
Q

Signs and symptoms of uncontrolled T1DM

A
  • Weight loss
  • Polyuria – excessive urination
  • Polydipsia – excessive thirst
  • Polyphagia – strong sensation of hunger
  • Hyperglycaemia – high blood glucose
  • Ketosis/ ketonuria – excessive ketone levels in blood
18
Q

What is HBa1C and how is it useful in monitoring/ diagnosing diabetes?

A
  • When glucose levels are high in blood, they attach to haemoglobin molecules, forming HbA1c
  • So, high blood glucose = high HbA1c
  • Reflects average glucose levels over an extended period
  • Maintaining HbA1c levels within target range is crucial for reducing risk of diabetes-related complications
  • Level of 6.5% of higher is indicative of diabetes, whereas between 5.7% and 6.4% is considered prediabetes
19
Q

What are AGE’s and what might they affect?

A

AGE = advanced glycated end-products; produced when increase in HbA1C
- Signals cells to make inflammatory proteins (adipokines)
- Deficient and compromised multipotent stromal cells regeneration of tissues and normally suppress bacterial growth
- Increased infections

20
Q

Why might an uncontrolled diabetic with type 1 diabetes mellitus be breathing rapidly?

A
  • Without insulin, cells unable to take up glucose from the blood for energy
  • Body begins breaking down fat stores for energy
  • Leads to production of ketones as a by-product
  • Ketones are acidic, so accumulation lowers blood pH
  • Bicarbonate in blood is used to buffer this decrease in pH
  • CO2 produced as a by-product of buffering
  • Accumulation of CO2 results in respiratory distress, i.e., rapid breathing to get rid of excess carbon dioxide in blood
21
Q

Why might an uncontrolled diabetic with T1DM seem hyperactive?

A
  • Blood glucose levels skyrocket due to insufficient insulin
  • Increased energy produced due to glucose going through respiration pathways (rather than uptake into cells for storage)
  • Can manifest as hyperactivity
22
Q

What is the polyol pathway and how does it cause visual blurring, cataracts, retinopath, nephropathy and neuropathy in T1DM?

A
  • Polyol pathway (glucose converted to fructose, sorbitol produced as intermediate)
  • In retina and kidney and neurons: sorbitol cannot cross cell membrane causes cells to lyse (osmotic stress)
  • Causes cataracts, retinopathy, nephropathy, neuropathy, visual blurring in T1DM
23
Q

How can type 2 diabetes mellitus be controlled?

A
  • Induced by an imbalance of energy (obesity, sedentary lifestyle, nutrition)
  • 90% of diabetics are T2DM
  • Strong genetic predisposition
  • Initially insulin resistance or reduced insulin function
  • Adipokine interference?
  • Roll of microbiome? Gut microbiome is impacted by diet
  • Lifestyle changes reduce T2DM occurrence/ to control T2DM: calorie restrictions for weight loss, raw, high fibre foods = low GI, stress reduction to lower cortisol = low BGL
  • If not controlled with these two, metabolic consequences arise
24
Q

Metabolic consequences of uncontrolled type 1diabetes mellitus

A
  • Decreased cellular uptake and utilisation of glucose by myocytes and adipocytes (GLUT4 transporters)
  • Gluconeogenesis – synthesis of glucose from acetyl-CoA
  • Increase in blood levels of HbA1C (glycosylated Hb)  increased infections (UTI, candida) – 15% hospital admissions for diabetics due to bacterial infections
25
Q

What health impacts can type 1 diabetes mellitus lead to?

A
  • Tooth decay, periodontitis (systemic disease?)
  • Glycosuria – sugars in urine (BGL > renal threshold)
  • Dehydration
  • Visual blurring (osmosis)
  • Cataracts, retinopathy, nephropathy, neuropathy
  • Vascular disease
  • Diabetic foot problems leading to amputations
  • Increased glucagon (no insulin to suppress secretion)
26
Q

Why is do diabetics see an increase in glucagon? What is the effect?

A

o Excessive mobilisation of fat stores, production of ketones
o Ketoacidosis: production of ketones (acidic) that are not required – lower blood pH
o Respiratory distress (bicarbonate used for blood pH buffering creating excess CO2)
o Increased adrenocorticotropin (ACTH) = increased cortisol (exacerbates hyperglycaemia
o Hyperlipidaemia – increased blood cholesterol and triglycerides
- Hyperglycaemia exacerbated as mitochondria will utilise ketones in preference to glucose if both in blood
HENCE NEED INSULIN ADMINISTRATION

27
Q

What are the metabolic consequences of uncontrolled type 2 diabetes mellitus?

A
  • Hyperglycaemia – initially no diabetic ketoacidosis
  • Increased advanced glycated end products (AGEs), as seen in T1DM
  • Hyperlipidaemia – increased blood cholesterol and triglycerides
  • Eventually beta cell apoptosis, leading to T1DM
  • Decrease in insulin levels as the disease increases in duration leading to transient diabetic ketoacidosis and requiring insulin
28
Q

What are adipokines and when are they produced?

A

Adipokines – inflammatory proteins
- Produced when AGEs signal certain cells to make them
- Can be due to an increase in blood levels of HbA1c