CLINICAL CASES
241
B IO C H E M IS T R Y PE A R L S
The liver uses two mechanisms for endogenous glucose production,
the mobilization of intracellular glycogen (glycogenolysis)
and the synthesis of glucose from noncarbohydrate precursors
(gluconeogenesis).
Flux of carbon through the pathways of hepatic glucose metabolism
described above is strongly influenced by the hormones insulin,
glucagon, and epinephrine.
Lack of insulin, in the face of elevated glucagon and epinephrine,
leads to high rates of hepatic glucose output, being driven by
P-oxidation of fatty acids. The latter results in an excessive
production of ketone bodies and subsequent ketoacidosis.
REFERENCES
Cohen P. Dissection of the protein phosphorylation cascades involved in insulin
and growth factor action. Biochem Soc Trans 1993;21:555.
Newsholme EA, Leech AR. Biochemistry for the Medical Sciences. New York:
Wiley, 1983.
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