Week 1

Question 1

What pathways in the liver is unregulated by insulin?

Answer 1

Fatty acid synthesis and glycogen synthesis. They responded to insulin signaling increased glucose.

Question 2

What tissue is most important for reducing elevated blood glucose in response to increased insulin?

Answer 2

Skeletal muscle

Question 3

Consuming a high carbohydrate meal will stimulate which pathways?

Answer 3

Liver glycogen synthesis

Question 4

A 35-year-old male hiker was lost in the wilderness for two weeks. During that time he drank water from streams but had almost nothing to eat. What fuels are made in the liver increased in the blood stream during the two-weeks of fasting?

Answer 4

Ketone bodies

Question 5

Glycogen is the branch chain storage form of glucose. Which organ contains the largest stores of glycogen?

Answer 5

skeletal muscle

Question 6

Following a high carbohydrate meal, you fast for 4-6 hours. Which of the following would be true in liver for a healthy patient in the fasting state compared with the fed state?

Answer 6

Increased glycogen degradation

Question 7

Later in the course we will discuss the effects of very low carbohydrate diets. Which of the following would you expect in a patient on a strict low carbohydrate diet relative to a patient on a standard diet?

Answer 7

Elevated serum ketones

Question 8

Most tissues in the body can use multiple fuel sources, e.g. fatty acids, amino acids, ethanol in addition to glucose. Which of the following tissues can only use glucose as fuel?

Answer 8

red blood cells

Question 9

There are reality TV shows where participants attempt to survive three weeks in remote
locations and find little to eat. The food they do find is typically fish, snakes, clams or other meat
with little carbohydrate. Despite their starvation diets these patients do not enter a hypoglycemic
coma. Which of the following best describes the physiological adaptation of these participants to
maintain their blood glucose levels for 21 days with few carbohydrates?

Answer 9

amino acids from skeletal muscle are converted to glucose

Question 10

A ketogenic diet can be evaluated by measuring the level of ketones in the blood. Which of the following is the primary substrate used to generate blood ketone bodies?

Answer 10

fatty acids

Question 11

List the primary macronutrients used as human energy sources

Question 12

Explain why red blood cells have an absolute requirement for glucose.

Question 13

Describe the effects of the fed and fasting state on insulin and glucagon.

Answer 13

In the fed state there is high insulin and low glucagon. In the fasting state there is low insulin and high glucagon

Question 14

Compare the fuels used by the liver in the fed versus fasting state.

Answer 14

During the fed state

Question 15

Recognize the structures of carbohydrates, fatty acids and proteins and list their major storage forms.

Question 16

Describe the molecule that is the major carrier of nitrogen that is
excreted from the body.

Question 17

Describe the primary metabolic effects in a patient who cannot make
insulin (Type 1 diabetes).

Question 18

Compare the different primary metabolic pathways in the liver that
maintain blood glucose levels in the fed and fasting state.

Question 19

Define Body Mass Index (BMI) and list the value indicating obesity.

Answer 19

Body-mass index is a measure of energy. It’s the ratio of mass to height. 19-24 kg/m^2 is normal. >30kg/m^2 is clinically obese. 25-29 is overweight, and <18.5 is under nourished.

Question 20

Contrast the characteristics of patients with marasmus versus
kwashiorkor.

Answer 20

Marasmus is when then patient has a deficiency of protein, energy, chronic, severe wasting. They have low insulin levels which allows proteolysis. Kwashiorkor is a protein deficiency but total calories adequate. Failure of protein synthesis in liver. Peripheral edema is a defining characteristic.