The liver maintains blood glucose levels during fasting through:
Glycogenolysis
Gluconeogenesis
The kidney can also perform gluconeogenesis, but to a lesser extent.
Regulation:
Promoted by glucagon and epinephrine (raise blood sugar)
Inhibited by insulin (lowers blood sugar)
During fasting:
Glycogen reserves decrease significantly within the first 12 hours.
Gluconeogenesis increases.
After 24 hours, gluconeogenesis becomes the primary source of glucose.
Important Substrates for Gluconeogenesis
Glycerol-3-phosphate:
From stored fats (triacylglycerols) in adipose tissue.
Lactate:
From anaerobic glycolysis.
Glucogenic amino acids:
From muscle protein.
Most amino acids are glucogenic EXCEPT leucine and lysine.
Glucogenic amino acids can be converted into intermediates that feed into gluconeogenesis.
Ketogenic amino acids:
Can be converted into ketone bodies.
Ketone bodies serve as an alternative fuel during prolonged starvation.
Dietary fructose and galactose can also be converted to glucose in the liver.
Acetyl CoA and Fatty Acids
In humans, glucose is converted into acetyl CoA via glycolysis and pyruvate dehydrogenase. However, acetyl CoA cannot be converted back to glucose.
Most fatty acids are metabolized to acetyl CoA and are thus not a major source of glucose.
Exception: Fatty acids with an odd number of carbon atoms (e.g., 17 carbons) yield propionyl-CoA, which is glucogenic.
Conversion of Gluconeogenic Intermediates
Lactate is converted to pyruvate by lactate dehydrogenase.
Alanine is converted to pyruvate by alanine aminotransferase.
Glycerol-3-phosphate is converted to dihydroxyacetone phosphate (DHAP) by glycerol-3-phosphate dehydrogenase.
Important Enzymes of Gluconeogenesis
Most steps are the reverse of glycolysis. The key enzymes bypass the irreversible steps of glycolysis (glucokinase, phosphofructokinase-1, and pyruvate kinase).
Four important enzymes to know:
Pyruvate carboxylase
Phosphoenolpyruvate carboxykinase (PEPCK)
Fructose-1,6-bisphosphatase
Glucose-6-phosphatase
Pyruvate Carboxylase
Location: Mitochondrial enzyme.
Activated by acetyl CoA from beta-oxidation.
Converts pyruvate to oxaloacetate (OAA).
OAA is a citric acid cycle intermediate that cannot leave the mitochondrion directly.
OAA is reduced to malate, which exits the mitochondrion via the malate-aspartate shuttle.
In the cytoplasm, malate is oxidized back to OAA.
Significance of Acetyl CoA Activation:
High acetyl CoA indicates the cell is energetically satisfied. It inhibits pyruvate dehydrogenase, so glucose isn't burned.
Pyruvate is shunted to pyruvate carboxylase for gluconeogenesis.
Acetyl CoA source is from fatty acids, not glycolysis in this case.
To reduce glucose in the liver during gluconeogenesis, fatty acids are burned to provide energy and stop the forward flow of the citric acid cycle.
This produces OAA, leading to glucose production.
Phosphoenolpyruvate Carboxykinase (PEPCK)
Location: Cytoplasm.
Induced by glucagon and cortisol (raise blood sugar levels).
Converts OAA to phosphoenolpyruvate (PEP).
Requires GTP.
PEP continues in the pathway to fructose-1,6-bisphosphate.
Pyruvate carboxylase and PEPCK bypass pyruvate kinase by converting pyruvate back into PEP.
Fructose-1,6-Bisphosphatase
Location: Cytoplasm.
Key control point and rate-limiting step of gluconeogenesis.
Reverses the action of phosphofructokinase-1 (rate-limiting step of glycolysis).
Removes phosphate from fructose-1,6-bisphosphate to form fructose-6-phosphate.
Phosphatases generally oppose kinases.
Regulation:
Activated by ATP.
Inhibited by AMP and fructose-2,6-bisphosphate (F26BP).
High ATP means the cell has enough energy to produce glucose for the body.
High AMP means the cell needs energy and can't afford to produce glucose for others.
Fructose-2,6-bisphosphate (F26BP):
Marker for satisfactory energy levels in liver cells.
Helps cells override the inhibition of phosphofructokinase-1 caused by high acetyl CoA levels.
F26BP (produced by PFK-2) controls both gluconeogenesis and glycolysis in the liver.
PFK-2 is activated by insulin and inhibited by glucagon.
Glucagon lowers F26BP and stimulates gluconeogenesis.
Insulin increases F26BP and inhibits gluconeogenesis.
Glucose-6-Phosphatase
Location: Lumen of the endoplasmic reticulum (ER) in liver cells only.
Glucose-6-phosphate is transported into the ER.
Free glucose is transported back into the cytoplasm (then diffuses out of the cell via GLUT transporters).
Absence in skeletal muscle:
Muscle glycogen cannot serve as a source of blood glucose.
Muscle glycogen is used only within the muscle.
Bypasses glucokinase and hexokinase (which convert glucose to glucose-6-phosphate).
Additional Notes
Alanine is a major glucogenic amino acid, but most amino acids are glucogenic.
Most glucogenic amino acids are converted to citric acid cycle intermediates, then to malate, following the same path to glucose.
Hepatic gluconeogenesis doesn't provide energy for the liver.
Gluconeogenesis requires ATP, provided by beta-oxidation of fatty acids.
Hepatic gluconeogenesis is dependent on beta-oxidation of fatty acids in the liver.
During low blood sugar, adipose tissue releases fatty acids by breaking down triacylglycerols into glycerol (converted to DHAP) and free fatty acids.
Acetyl CoA from fatty acids cannot be converted into glucose directly, but it can be converted into ketone bodies as an alternative fuel (including for the brain).
Extended periods of low blood sugar are accompanied by high levels of ketones in the blood.
Ketone bodies serve as a transportable form of acetyl CoA, primarily utilized during extended starvation.