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Digestive and Renal Sciences > Fed, Fasted and Starvation > Flashcards

Fed, Fasted and Starvation Flashcards

1
Q

What is the absorptive state known as?

A

Fed State, just after eating a meal and therefore are actively absorbing nutrients.

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2
Q

What is the post absorptive state?

A

Fasted state, after nutrients and energy has already been absorbed and therefore you must acquire energy from the stores within the body.

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3
Q

Where do the absorbed nutrients enter into first and which organ is required?

A

Portal blood first

First port of call is the liver

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4
Q

In the liver what is glucose converted to?

A

Glycogen

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5
Q

In muscle what is glucose converted to?

A

Glycogen

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6
Q

In other tissues what can glucose be converted to?

A

Kerbs cycle energy

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7
Q

In adipose tissue what can Glucose be converted to?

A

TG

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8
Q

What are amino acids converted to in the liver?

A

Keto acids and energy

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9
Q

What are amino acids converted to in the muscles?

A

Proteins

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10
Q

What is the hormone controlling the switch between post absorptive and absorptive states?

A

Insulin.

Due to increased glucose and insulin in the blood

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11
Q

Where is insulin secreted?

A

Beta cells of the islets of Langerhans in the pancreas.

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12
Q

What is the trigger for insulin release?

A

High blood glucose and amino acid levels

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13
Q

Which transported is responsible for glucose uptake into the beta cells?

A

GLUT2 which is insulin insensitive.

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14
Q

What happens when glucose is transported into the beta cells.

A

Triggers generation of ATP from glucose metabolism and Ca influx
Raised intracellular Ca causes insulin exocytosis.

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15
Q

After insulin is released what leads to glucose uptake in cells?

A

After insulin secretion
GLUT4 is recruited to cells and enables glucose to be up taken.
This leads to decreased blood glucose concentration and therefore removal of insulin

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16
Q

What does insulin do when it is present in the liver after receptor is stimulated?

A

Makes no difference to GLUT2 on liver surface

Stimulates
Increased Glycogen synthesis
Increased Glycolysis
Decreased Glycogenolysis

17
Q

What is the role of insulin in muscle cells?

A

Drives GLUT4 to the cell membrane allowing for increased glucose uptake.
Increase glycogen synthesis
Increase glycolysis
Increase lipogenesis

18
Q

What is the role of insulin in adipocytes?

A

Drives GLUT4 is recruited to the membrane
Increased glucose up take
Increased Glycolysis and TG synthesis
Stimulate Lipogenesis and inhibit lipolysis

19
Q

What is being utilised when in the post absorptive state?

A

Utilisation of energy stores since glucose is not being absorbed from the GIT

20
Q

What reactions to ultilise energy from stores occur when in the post absorptive state?

A

Glucose supplying reactions (reactions generating glucose)

Glucose sparing reactions (reactions which generate other energy substrates such as FAs)

21
Q

What is the biggest contributor for energy in the post absorptive state?

A

Glucose sparing reactions

22
Q

What is a common example of a glucose supplying reaction and where do they occur?

A

Glycogenolysis
Gluconeogenesis

Occurs in the liver

23
Q

What examples are there for glucose sparing reactions?

A

Beta oxidation of fats from adipose tissue into Free FAs which enter the blood to be oxidised at other targets.

24
Q

What is diabetes mellitus characterised by?

A

High blood sugar

25
Q

What is Type 1 diabetes?

A

Young onset
Destruction of beta cells and therefore loss of insulin
Severe metabolic derangement due to inability to utilise glucose
(effectively stuck in the fasted state)

26
Q

What are some characteristics of type 1 diabetes?

A

Use other fuels for energy (fasted state)

leads to marked weight loss and metabolic disturbance

27
Q

What is Type 2 diabetes?

A

Prevalence increases with age
Insulin levels usually normal or high but has reduced action
Treated with lifestyle (diet) or insulin

28
Q

What kind of damage does type 2 diabetes lead to?

A

Cause long term damage due to high glucose levels and lipid abnormalities.
less Severe metabolic derangements

29
Q

What happens in type 1 diabetes in the liver?

A

Decreased glycogen synthesis

Increased glycogenolysis

30
Q

What happens in type 1 diabetes in adipocytes?

A

Decreased glucose uptake since GLUT4 is not being recruited
Increased lipolysis

Breakdown of fats releasing fatty acids into circulation (used as alternative energy source to glucose)

31
Q

What happens in type 1 diabetes in muscles?

A

Increased extracellular glucose as it cannot be absorbed since GLUT4 is not being recruited

Breakdown of protein to amino acids as substrates for gluconeogenesis

32
Q

What does type 1 diabetes in muscles lead to?

A

Muscle wasting

33
Q

What are the problems with metabolic derangement caused by diabetes?

A

Level of glucose in blood is high because uptake is not stimulated.
Insulin is not produced and therefore mediated inhibition of glycogenolysis and lipolysis cannot occur

34
Q

What is the major issue with diabetes affecting the liver?

A
  1. Increased circulation of FAs directed to the liver where they are used in beta-oxidation.
  2. Increase in Acetyl CoA generated in hepatocytes which inhibits Krebs pushing Acetyl CoA towards ketogenesis.
  3. Ketones then used in extra hepatic tissues where it is reconverted into Acetyl CoA where it can then enter krebs outside of the liver.
35
Q

What are some clinical features of uncontrolled diabetes?

A

Polyuria (glucose reabsorption exceeded leading to glucosuria and thus more urination) Polydipsia(thirst)
Dehydration

Infections (thrush)
Weight loss (muscle and fat wasting)

Metabolic acidosis (due to ketones) leading to confusion or coma

36
Q

What treatments are there for uncontrolled diabetes?

A

Rehydration with IV saline

Insulin

Monitor correct serum electrolytes

37
Q

What is the impact of chronic diabetes?

A

High glucose may have other adverse metabolic effects as high glucose is toxic.

Advanced Glycation (altering protein function)

Sorbitol Toxicity (leads to glycation of other tissues)

38
Q

What are the long term metabolic consequences microvascular?

A

Retinopathy - leads to blindness / vision impairment

Nephropathy - kidney damage leading to kidney failure

Neuropathy - Decreased sensation as well as impaired immune and wound healing system

39
Q

What are some macrovascular complications?

A

Atherosclerosis
strokes
heart attacks

Digestive and Renal Sciences (26 decks)

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