My cards Flashcards
Is glycation an enzyme-dependent process?
no, it’s a non-enzymatic process
Name non-enzymatic processes?
- Glycation
- conversion of creatine and creatine-p to creatinine for excretion
CHO-digesting enzymes in the SI
o Pancreatic amylase, glucoamylase
CHO-digesting enzymes on the brush-border of SI
o Sucrase‐isomaltase
o Lactase
What does histamine release in lactose intolerance lead to?
SWELLING of bronchi-> anaphylaxis
Gene that codes for GLUT1-5
SLC2A1-5
- Is glucose an energy demanding process?
Not directly, but Na/K ATPase does require ATP to set up the gradient
Galactose is preferentially converted to __; fructose is preferentially converted into __ and __
Galactose is preferentially converted to glycogen; fructose is preferentially converted into FA and TG
Normoglycemic range
between 4 and 6 mmol/L
What can pyruvate can be converted into/used for?
o lactate; o Acetyl-CoA for TCA; o amino acid synthesis o fatty acid synthesis o glycogen- via Acetyl-CoA in glycogenesis
What is the role of glucose-6-phosphatase
converts glucose-6-phosphate into glucose which allows it to be transported out of the cell
Possible fates of glucose 6-phosphate
- Go through glycolysis
o metabolic pathway that converts glucose C₆H₁₂O₆, into pyruvate - Be made into glycogen: phosphate group has to be moved from 6 to 1 Carbon by phosphoglucomutase
o It then has to be activated with UTP and incorporated into glycogen
What does Coenzyme A synthesis require?
Coenzyme A biosynthesis requires cysteine, pantothenate (vitamin B5), and adenosine triphosphate (ATP)
Can acetyl-CoA be converted into glucose?
no
When does gluconeogenesis begin?
4h after the meal
How do levels of FA in the circulation change? Levels of 3-hydroxybutyrate?
FA- steady after rapid increase in the first few days
3-HB- Rapidly increasing until day 20, then slower increase rate
Estimated BMR of males and females
o males: 1.0 kcal/kg/h ~~ 1700 kcal/d
o females: 0.9 kcal/kg/h ~~ 1200 kcal/d
o The longer the fast, the closer the RQ to __
o The longer the fast, the closer the RQ to 0.7
Does insulin have long or short half-life
short
Measure of insulin production
measure c-peptide levels in urine in 24h
Role of Carboxypeptidase E
• In vesicles there’s carboxypeptidase E which cleaves the c-peptide-> mature insulin, stored in the vesicle
Where is insulin stored? In which form
in vesicles in beta-cell
- Insulin is stored as a hexamer- 6 insulin molecules together- most stable form
Who discovered insulin?
Charles Best, Frederick Bantign have discovered insulin
Anaphylactic shock is a reaction to a __
Anaphylactic shock is a reaction to a protein
Which diabetes type has C-peptide present
T2 only
Urinlaysis tets
- Glucosuria/Ketonuria – urinalysis
* Dipstick with markers that change colour depending on glucose concentration
• Fasting plasma glucose concentration test values
7.0 mmol/L is suggestive of diabetes
normal 5 mmol/L
RBC lifespan
120 days
What is gliovascular disease
- Damage to small blood vessels
What is Macrovascular disease?
Some damage to larger arteries, but it is very minor. More caused by T2DM
T2DM prevalence: men vs women
More prevalent in men
Hyperglycemic Hyperosmolar Nonketotic Syndrome
What is it? T2 vs T1DM
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNK), s a dangerous condition resulting from very high blood glucose levels. HHNS can affect both types of diabetics, yet it usually occurs amongst people with type 2 diabetes
• More prevalent I Elderly
• Affects the brain lethargy, sleepiness
• Importance of adequate water intake
Possible mechanism of decreased insulin sensitivity in T2Dm
- Insulin receptor substrate 1 (IRS1) is a major signaling protein after insulin receptor
o In diabetes it becomes less effective in translating the signal caused by insulin binding
o The decreased effectiveness is caused by activation of cell’s coping mechanisms due to increased stress which starts in the cytoplasm and translates into ER
Increased stress is caused by increased obesity, excess fatty acids etc
o ER sends signals to IRS1 and inactivate it and prevents it from being activated by insulin - IRS1 is activated less efficiently by insulin -> less LGUT4 is released form vesicle
- Less GLUT4-> lower glucose absorption (but not cut off)
- This means that all the other anabolic response of the cells is decreased: less protein synthesis, less cell division
__ and __ is specific for T2
Atherosclerosis and increased VLDL is specific for T2
Microvascular diseases are related to increased levels of __
Microvascular diseases are related to increased levels of hexokinase (converts glucose to glucose-6-phosphate which cannot cross the membrane
Metformin effects
o Increases peripheral insulin sensitivity – increases removal
o Increases GLUT4 mediated glucose uptake- increases the output
o Increases fatty acid oxidation- increases the output
Metformin- principle of action
- Increases phosphorylation of AMPK which is a master regulation. That results in increase in
o Increase in GLUT4 and glucose intake
o Decreases SREBP1
-> Decreases hepatic fatty acid synthesis, VLDL synthesis-> decreases atherosclerosis; decreases fat all together, decreases TGs-> decreases fatty liver
-> Increases FA oxidation
o Decreases gluconeogenesis in the liver
o This results in decreased blood glucose and decreased plasma TGs
Sulfonylureas- mode of action
Target beta cells to increase insulin production and release (close K+ channels in beta cells)- assists b-cells to be more effective at releasing insulin
Close K channel, resultign in cell depolarization and opening of Ca2+ channels
What does opening of Ca2+ channels result in?
Ca2+ activates insulin gene expression via CREBP (Calcium Responsive Element Binding Protein)-> making more insulin
Ca2+ also causes exocytosis of stored insulin to the cell membrane
Are Sulfonylureas effective in all diabetic patients?
No, as their action is dependent upon the presence of functioning Beta cells, therefore, sulfonylureas do not work in people with type 1 diabetes.
What are incretins?
- Incretins are a group of endogenously made hormones that lower blood glucose by increasing or potentiating insulin and its effects
o A lot of them come from the gut
Gut hormones – GLP1 – (glucagon‐like peptide 1)
GIP (gastric inhibitory peptide)
Both increase insulin and decrease glucagon release- there are always both of them in circulation at any 1 time
Stimulate glucose uptake
How are incretins inactivated? What are the consequences?
Are inactivated by the enzyme DPP‐4 (diphenylpeptidease 4)
• Thus incretins have short half-life-> analogue drugs were created
What are incretin drugs? + and -
: exogenous analogues of GLP1 and GIP an inhibitors of DPP-4- 3 different drugs
o Expensive
o Proteins-> have to injected
o All 3 can be used at the same time
Catabolic response to surgery
- Surgery causes inflammatory response due to pro-inflammatory cytokines being released
o They promote protein breakdown and cause insulin resistance
o Result in decreased appetite and food intake
o Decreased GI function
o Decreased blood flow
Neuroendocrine response aka hypothalamic- pituitary axis
o Pain signals go into the brain causing release of cortisol stress hormones
o Causes release of glucagon
o They cause insulin resistance and counteract the effects of insulin
o That results in hyperglycemia and increases complication and causes breakdown of protein
Why shouldn’t we administer glucose via vein to patients?
If we feed glucose via a vein-> no secretion of incretins as they are gut hormones -> less insulin secretion for a given amount of glucose and a higher glucose level
at any time we have _g of plasma glucose
at any time we have 4g of plasma glucose
How to calculate NB?
Nitrogen Balance = N Intake – fecal N – urinary N (– misc losses)
How much protein is absorbed from the diet?
95%
How much of ingested protein is excreted in urine and in feces?
o 5% is excreted in feces
o 95% excreted in urine
- calculations take into account that protein is __% nitrogen
- calculations take into account that protein is 16% nitrogen
- Someone sick will have __ nitrogen balance
- Someone sick will have negative nitrogen balance
What does AA inflow include
inflow = input = Intake + Protein breakdown + De novo synthesis
What does AA outflow include
synthesis (AA incorporated into protein) + catabolism
__ = __ in people in nitrogen balance
- Rate of protein synthesis = rate of protein breakdown in people in nitrogen balance
How large is AA pool
300g
Why do we still need to consume AA if we recylce them?
no recycling program is perfect, there is a certain amount of obligatory losses, AAs that need to be metabolized for other functions (hormones, NTs)
- to keep cycle going need about about .8/ kg (0.6 is an average)
Can NB bes used to differentiate protein synthesis rates?
no
In what situation would increased protein intake stimulate protein syntheisis?
Only when we were initially under consuming protein
If we were consuming enough, increased intake wouldn’t drive protein synthesis
Steps of AA breakdown
remove amino group, transfer amino group ultimately to urea
o Carbon skeleton will remain, that will go to CO2 when oxidized