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Glucose
- The form of sugar that circulates in the blood and provides the major source of energy for body tissues. When its level is low, we feel hunger.
Carbohydrates
- The starches and sugars present in foods, broken down into glucose to provide energy
Common Formula for Carbohydrates
- Cn(H2O)n
- "Watered carbon"
Glucose: Formula
C6H12O6

Monosaccharides
- The simplest carbohydrates
Key Monosaccharides
- Glucose, Fructose, Galactose

Glucose, Fructose, Galactose: How are they similar? How are the different?
- Similar: All have the same chemical formula C6H12O6
- Different: They are isomers with different spacial orientations
Disaccharides
- Carbohydrates that are made up of two monosaccharides
What happens to disaccharides in the GI tract?
- Broken down into monosaccharides → then absorbed
Lactose
- Galactose + glucose
What breaks down Lactose? What happens when someone is lacking in this enzyme?
- Lactase
- Lactose intolerance
Sucrose
- Glucose + fructose, found in table sugar
What breaks down Sucrose?
- Sucrase
Polysaccarides
- Polymers of monosaccharides
Common Polysaccharides
- Starch
- Glycogen
- Cellulose
Starch
- A storage polysaccharide in plants consisting entirely of glucose.
Glycogen
- An extensively branched glucose storage polysaccharide found in the liver and muscle of animals; the animal equivalent of starch.
Cellulose
- A substance (made of sugars) that is common in the cell walls of many organisms, cannot be broken down by animals
- "Fiber" in diet → improved bowel function
How can glucose be used in the body?
ATP production, amino acid synthesis, glycogen synthesis, triglyceride synthesis

Which organ has the most varied use of glucose?
Liver
- TCA for ATP
- Glycogen synthesis
How does the brain use glucose?
- Constant use of glucose for TCA cycle (ATP)
- Little glycogen storage
How do muscles/heart use glucose?
- Transport of glucose into cells is heavily influenced by insulin; more insulin → more glucose uptake
- TCA (ATP) and can store glucose as glycogen
How do RBCs use glucose?
- Only use glucose for anaerobic metabolism (generates ATP) because they lack mitochondria → generates lactate
How does Adipose Tissue use glucose?
- Converts glucose into fatty acids
- Uptake is influenced by insulin
How does glucose enter cells?
- Na+ independent entry
- Na+ dependent entry
Na+ Independent Entry
- GLUT-1 to GLUT-14 (uses [c] gradient)
- Varies by tissue (RBCs use GLUT-1)
Na+ Dependent Entry
- Glucose is absorbed from low [c] → high [c]
- Intestinal epithelium and renal tubules
How is Glucose Absorbed By Intestinal Epithelial Cells?
1. In GI lumen (left), you have low [glucose] compared to inside the cell
2. In order to absorb glucose, the cell will couple that absorption with sodium to move against [c] gradient (SGLT1, Na+ dependent)
3. [glucose] inside cell is higher than in interstitium/blood, so glucose can move down [c] gradient via GLUT2 (Na+ independent) into interstitium
4. Sodium previously uptaken by SGLT into cell (coupled to glucose) is pumped back out into GI Lumen to create high [Na+] outside of cell; this sodium can then be reused as a cotransporter for more glucose
![<p>1. In GI lumen (left), you have low [glucose] compared to inside the cell</p><p>2. In order to absorb glucose, the cell will couple that absorption with sodium to move against [c] gradient (SGLT1, Na+ dependent)</p><p>3. [glucose] inside cell is higher than in interstitium/blood, so glucose can move down [c] gradient via GLUT2 (Na+ independent) into interstitium</p><p>4. Sodium previously uptaken by SGLT into cell (coupled to glucose) is pumped back out into GI Lumen to create high [Na+] outside of cell; this sodium can then be reused as a cotransporter for more glucose</p>](https://assets.knowt.com/user-attachments/9605a7db-1048-463d-a772-d9405d1b32fa.png)
GLUT-1: Insulin dependent or independent? Its result? Where is it utilized?
- Insulin Independent → uptake of glucose when [c] is high, less uptake when [c] is low (no influence from insulin)
- Location: Brain and RBCs
GLUT-4: Insulin dependent or independent? Its result? Where is it utilized?
- Insulin Dependent
- Fat tissue, skeletal muscle
GLUT-2: Insulin dependent or independent? Its result? Where is it utilized?
- Insulin independent
- Liver, Kidneys, Intestines, Pancreas
What is the directionality of GLUT-2?
- Bidirectional: Can transport glucose OUT of cells for gluconeogenesis
Which organs synthesize glucose for the body via gluconeogenesis?
- Liver and Kidney → they have GLUT-2 (bidirectional) so they can take up glucose but also put it back into bloodstream
What role does GLUT-2 have in Intestinal Cells?
- Transports glucose OUT of epithelial cells (from lumen) → portal vein

Glycolysis
- The breakdown of glucose by enzymes, releasing energy and pyruvic acid.

Which cells use glycolysis? Where does it occur within cells?
- ALL cells of the body
- Sequence of rxns occur in cytoplasm
What conversion happens in glycolysis? What does it generate?
- Converts: Glucose (6 carbons) → private (3 carbons)
- Generates: ATP and NADH
NADH
- The reduced form of NAD+; an electron-carrying molecule that functions in cellular respiration
- Generated during glycolysis
Cellular Respiration
- Process that releases energy by breaking down glucose and other food molecules in the presence of oxygen
NAD+ vs NADH
- NAD+: Accepts electrons
- NADH: (Made during glycolysis) Dontaes electrons to ETC → generates ATP
Are the reactions of glycolysis mostly reversible or irreversible? What does this allow?
- Majority of rxns are reversible
Allows for:
- When the level of one substrate gets high, ex. 3-phosphoglycerate, more 2-phosphoglycerate is generated
- On the other hand if [2-phosphoglycerate] is high, more 3-phosphoglycerate would be generated
MEANS RXNS CAN BE USED IN BOTH GLYCOLYSIS AND GLUCONEOGENESIS
![<p>- Majority of rxns are reversible</p><p>Allows for:</p><p>- When the level of one substrate gets high, ex. 3-phosphoglycerate, more 2-phosphoglycerate is generated</p><p>- On the other hand if [2-phosphoglycerate] is high, more 3-phosphoglycerate would be generated</p><p>MEANS RXNS CAN BE USED IN BOTH GLYCOLYSIS AND GLUCONEOGENESIS</p>](https://assets.knowt.com/user-attachments/2cea7ec2-77cb-43da-b7d3-3fb8fb28f143.png)
Which Reactions of Glycolysis are Irreversible?
1. Glucose → Glucose-6-Phosphate
2. Fructose-6-Phosphate → Fructose-1,6-Bisphoshate
3. Phosphoenolpyruvate (PEP) → Pyruvate
What are the stages of Glycolysis?
1. Priming/Investment stage: Where the cell invests energy (spends ATP) to convert glucose to a more favorable structure to go through remaining rxns
2. Splitting Stage: The 6-carbon structure is divided into 2x 3-carbon structures
3. Energy Stage: Where ATP is generated

Glucose → Glucose-6-Phosphate: What enzyme catalyzes this rxn?
- Hexokinase
- Glucokinase

Hexokinase: Which rxn does it catalyze? Where is it found? Insulin dependent/independent?
- Rxn: Glucose → Glucose-6-Phosphate (Uses ATP)
- Location: Most Tissues
- Insulin Independent

What is Hexokinase Inhibited by? Its result?
- Inhibited by G-6-P → Prevents cells from hoarding glucose
High [G-6-P] means cells have satisfied their metabolic requirements, meaning it doesn't need more glucose → prevents further rxns from Hexokinase
![<p>- Inhibited by G-6-P → Prevents cells from hoarding glucose </p><p>High [G-6-P] means cells have satisfied their metabolic requirements, meaning it doesn't need more glucose → prevents further rxns from Hexokinase</p>](https://assets.knowt.com/user-attachments/f1bdc10c-1615-421b-89d9-a3d2decff9af.png)
Hexokinase: Kinetics (Km/Vm)
- Low Km: High affinity for glucose. It binds glucose very readily, even when glucose concentration is low.
- Low Vm: Even if you give it tons of glucose, it has a relatively low maximum rate at which it can process it.

Glucokinase: Which rxn does it catalyze? Where is it found? Insulin dependent/independent?
- Rxn: Glucose → Glucose-6-Phosphate (Uses ATP)
- Location: Liver/Pancreas
- Induced by Insulin
What is Glucokinase Inhibited by? Inhibition is overcome by what?
- Fructose-6-Phosphate
- Inhibition overcome by ↑↑ [Glucose]
![<p>- Fructose-6-Phosphate</p><p>- Inhibition overcome by ↑↑ [Glucose]</p>](https://assets.knowt.com/user-attachments/5c2b31bd-afda-4a90-aeda-057218f84e31.png)
When is Glucokinase inactive?
- In a fasting state → ↓ [Glucose] and ↑ [F6P]
- F6P is high because pyruvate is undergoing gluconeogenesis → you want to shut down glucokinase to prevent further processing of glucose
Glucokinase: Kinetics (Km/Vm)
High Km:
- Glucokinase doesn't bind glucose very well when glucose levels are low.
- It becomes much more active when there's lots of glucose around, like after a meal
High Vm:
- Once glucose is abundant, glucokinase can process large amounts of glucose quickly.

How does F6P Inactivate Glucokinase? How does Glucose overcome this inactivation?
1. F-6-P encourages Glucokinase Regulatory Protein to bind to glucokinase → translocated to the nucleus → inactivation of enzyme → no more glycolysis
2. When [Glucose] ↑↑ → Competes with GKRP for GK binding → GK goes back to cytosol where it can participate in glycolysis to generate ATP/NADH
![<p>1. F-6-P encourages Glucokinase Regulatory Protein to bind to glucokinase → translocated to the nucleus → inactivation of enzyme → no more glycolysis</p><p>2. When [Glucose] ↑↑ → Competes with GKRP for GK binding → GK goes back to cytosol where it can participate in glycolysis to generate ATP/NADH</p>](https://assets.knowt.com/user-attachments/5c4d391f-3095-4e65-a13c-0a2d7328cad9.png)
Hexokinase vs Glucokinase: What is their activity in the setting of Low blood sugar? Its result?
- Hexokinase: Active (No inhibition by G6P)
- Glucokinase: Inactive (not working when ↓ [Glucose])
GLUCOSE GOES TO TISSUES FOR USE, NOT LIVER
Hexokinase vs Glucokinase: What is their activity in the setting of High blood sugar? Its result?
- Hexokinase: Inactive (inhibited by G6P)
- Glucokinase: Active (↑ [glucose] → glucokinase freed from nucleus)
GLUCOSE GOES TO LIVER TO BE STORED AS GLYCOGEN
Glucokinase Deficiency
- If deficient → less uptake of glucose by liver/pancreas → mild hyperglycemia
Glucokinase Deficiency is exacerbated by what?
- Pregnancy
What is the rate limiting step in glycolysis?
PFK-1
Fructose-6-Phosphate → Fructose-1,6-Bisphosphate: What enzyme catalyzes this rxn?
- Phosphofructokinase-1 (uses ATP)
- Commits glucose to glycolysis

Phosphofructokinase-1: Key Inhibitors and Inducers
Inhibitors (↓ Glycolysis):
- Citrate (from TCA cycle), ATP (MEANS THE CELL ALREADY HAS HIGH ENERGY)
Inducers (↑ Glycolysis):
- AMP, Fructose-2,6-Bisphosphate (MEANS THE CELL NEEDS MORE ENERGY)
What are the roles of PFK1 and Fructose-1,6-Bisphosphatase 1?
- PFK: F6P → F16BP (Glycolysis)
- Fructose-1,6-Bisphosphatase 1: F16BP → F6P (Gluconeogenesis)
The relative activity of the two enzymes will determine if the cell utilizes glycolysis or gluconeogenesis

How do Insulin/Glucagon control the rate of glycolysis/gluconeogenesis?
- Via Fructose-2,6-Bisphoshate
Fructose-2,6-Bisphoshate
- Activates PFK-1 → drives cell towards glycolysis
- Inhibits Fructose-1,6-BP1
Fructose-2,6-Bisphoshate: What does it do when its [c] is high or low?
- High → Glycolysis ON
- Low → Glycolysis OFF
Fructose-2,6-Bisphoshate: How is it synthesized?
- Fructose-6-Phosphate, one of the molecules its supposed to regulate

What is the role of PFK2/FBPase2?
- They control the conversion of F6P ↔ F26BP
How do Insulin and Glucagon affect Fructose-2,6-Bisphoshate? Its Result?
- Insulin: Dephosphorylates PFK2/F16BP → ↑ Fructose 2,6 BP → Activates Glycolysis
- Glucagon: Phosphorylates PFK2/F16BP → ↓ Fructose 2,6 BP → Activates Gluconeogenesis

Glycolysis: Splitting Stage
- 1x (6 carbon) molecule of Fructose-1,6-BP → 2x (3 carbon) molecules of Glyceraldehyde-3-Phosphate

Glycolysis: Energy Stage
- Starts with 2x Glyceraldehyde-3-Phosphate → ends in pyruvate

What Is Generated During the Energy Stage of Glycolysis?
- 4 ATP, 2 NADH (2x ATP and 1x NADH per GAP, and there are 2x GAP)
- 2 net ATP generated because 2x are used during investment stage
Phosphoenolpyruvate → Pyruvate: What enzyme catalyzes this rxn?
- Pyruvate Kinase

Pyruvate Kinase: Key Inhibitors/Inducers
- Inhibitors: ATP and Alanine
- Inducers: Fructose-1,6-BP (Feedforward activation)

What effect do Glucagon/Epinephrine have on Pyruvate Kinase? Its result?
- They phosphorylate it → inactivates PK
- Slows glycolysis and favors gluconeogenesis
Alanine: Where is it made/why? What do its levels in the body indicate?
- Where/Why: Skeletal muscles degrade proteins for energy → produces alanine → sent to blood/liver
- Indicates: A lack of glucose throughout the body
Why is Alanine an Inhibitor of Pyruvate Kinase?
- Indicates low [glucose] in body bc muscles are degrading proteins for energy
- When alanine goes to liver, it inhibits PK → slows down glycolysis; liver then converts alanine back into glucose via gluconeogenesis → sent back to muscles as glucose for energy
![<p>- Indicates low [glucose] in body bc muscles are degrading proteins for energy</p><p>- When alanine goes to liver, it inhibits PK → slows down glycolysis; liver then converts alanine back into glucose via gluconeogenesis → sent back to muscles as glucose for energy</p>](https://assets.knowt.com/user-attachments/eda62d49-6977-45e6-b7a4-77bb65206a1f.png)
What is the end product of glycolysis? What can it generate?
- Product: Pyruvate
- Generates: Lactate or Acetyl-CoA (for TCA)
What happens when the TCA cycle is unavailable? (Ex. ↓ O2)
- Pyruvate is shunted to lactate
Lactate Dehydrogenase
- Converts pyruvate to lactate, uses NADH (regenerates NAD+)

When are levels of Lactate Dehydrogenase common?
- Hemolysis
- Myocardial Infraction
- Tumors
Level of NAD+ in cells
- They have a limited supply NAD+, needs to be regenerated in order to continue conducting glycolysis
How is NAD+ regenerated: O2 present vs O2 Absent?
- Present: NADH made in glycolysis can go to mitochondria → NAD+ regenerated in oxidative phosphorylation (that makes ATP)
- Absent: TCA/Oxidative phosphorylation are not available; pyruvate → lactate is important for regenerating NAD+
Lactic Acidosis: MOA
1. ↓ O2 → ↓ Pyruvate entry into TCA → Shunted to Lactic acid production to regenerate NAD+
2. ↑ Lactic acid → ↓ pH and HCO3

When is Lactic Acidosis seen clinically?
- Sepsis, bowel ischemia, seizures
Too much exercise can result in what?
1. Excessive exercise → NAD+ overcomsumed (TCA can't keep up)
2. Cells favor pyruvate → lactate
3. ↑ Lactate → ↓ pH in muscles → cramps
Pyruvate Kinase Deficiency: Inheritance; What age does it present at?
- Autosomal Recessive
- Usually presents in newborns
Pyruvate Kinase Deficiency: Which cells are most affected? Its result?
- Affected: RBCs bc/ they lack mitochondria
- Result: RBCs require PK for anaerobic metabolism. If deficient, → ↓ ATP → RBC membrane failure → Phagocytosis in spleen
Pyruvate Kinase Deficiency: Presentation
- Extravascular hemolysis: The destruction of red blood cells outside the blood vessels → Hemolytic Anemia
- Splenomegaly
Disease severity ranges based on enzyme activity
2,3 Bisphosphoglycerate
- Compound that lowers hemoglobin's affinity to oxygen, thereby freeing up oxygen for use by tissues; 2,3-BPG levels are higher in those acclimated to high altitudes
How much energy can a cell derive from a molecule of glucose using glycolysis?
ATP yield depends on whether cell has mitochondria and O2 present
Oxygen and Mitochondria Present
32-30 ATP
- 32: Malate-Aspartate Shuttle (Liver/Heart)
- 30: Glycerol-3-Phosphate Shuttle (Muscle)
Oxygen and Mitochondria Absent
2 ATP
What is the end product of glycolysis?
- Pyruvate
Why would Pyruvate be transported to the mitochondria?
- Can enter either TCA cycle (ATP) or Gluconeogenesis (Glucose)
How is Pyruvate transported to the mitochondria?
- Outer membrane: Voltage-gated porin complex
- Inner: Mitochondrial pyruvate carrier
What can Pyruvate encounter after moving into the mitochondria?
- Pyruvate Carboxylase: Shunts pyruvate back to gluconeogenesis
- Pyruvate Dehydrogenase Complex: Pyruvate → Acetyl-CoA → TCA

How does high [ATP] shunt pyruvate to gluconeogenesis?
1. High levels of ATP slow down TCA cycle
2. If TCA slows, Acetyl-CoA ↑↑↑
3. High [Acetyl-CoA] activates Pyruvate Carboxylase → shunts pyruvate to gluconeogenesis
![<p>1. High levels of ATP slow down TCA cycle</p><p>2. If TCA slows, Acetyl-CoA ↑↑↑ </p><p>3. High [Acetyl-CoA] activates Pyruvate Carboxylase → shunts pyruvate to gluconeogenesis</p>](https://assets.knowt.com/user-attachments/e3f20721-4bfa-414a-85a3-622a2c5bc2ed.png)
Where does Pyruvate go when Acetyl-CoA levels are high/low?
- High: Gluconeogenesis
- Low: TCA for ATP
Pyruvate Dehydrogenase Complex
- Pyruvate Dehydrogenase (E1)
- Dihydrolipoly Transcetylase (E2)
- Dihydrolipoly Dehydrogenase (E3)
Pyruvate Dehydrogenase Complex: Cofactors
- NAD+
- FAD
- Coenzyme A (CoA)
- Thiamine
- Lipoic Acid
Pyruvate Dehydrogenase Complex: Role of E1
- Adds Thiamine-PP to Pyruvate → Adds carbon skeleton of pyruvate to thiamine pp
- Releases CO2

Pyruvate Dehydrogenase Complex: Role of E2
- Pyruvate:Thiamine is attached to lipoic acid
- Co-A is then added to this structure to generate Acetyl-CoA

Pyruvate Dehydrogenase Complex: Role of E3
- Uses NAD/FAD cofactors to keep lipoic acid in proper form, so E2 can use it to create Acetyl-CoA
Thiamine
- B1 vitamin necessary to use glucose