I.

Starvation and Stress

a. Early Glucose
b. Later fatty acid and ketones
c. Starvation and trauma break down lean muscle to make glucose (fuel) there is a
difference with inulin and trauma due to a slight hormonal difference in which you
can use
II. Early Starvation
a. Drop in insulin level because BG is falling
b. Major catabolic hormones
i. Epinephrine
ii. Glucagon (secondary gluconeogenic pathway)
iii. Cortisol (much stronger stimulator of gluconeogenesis)
c. Glycogenolysis will be turned on doesnt last forever
d. Gluconeogenic pathway also provides glucose (need substrates)
i. Amino acid Alanine and Lactate
ii. Contributed by muscle (and other tissues RBC and brain for lactate)
iii. Glucose is taken up by muscle major fuel source for muscle (wont be taking
as much glucose because needs GLUT4 an insulin dependent receptor)
1. Doesnt metabolize it fully (pyruvate or lactate) not fully oxidized no
TCA cycle
2. Alanine is made from add amino group to pyruvate (alanine
generation) or breakdown of muscle proteins
a. Glutamate is transferred to pyruvate forming alanine and
alphaketogluterate transferred from pyruvate in muscle
b. Under conditions of high cortisol to supply alanine for
gluconeogenesis
c. But needs to be regenerated from other amino acids during
starvation (the donor amino acid will be an alpha keto-acid
transamination)
3. Lactate leaves the muscle and taken up by liver
4. Glutamine is also being made and generated by alphaketogluterate to
glutamate and glutamine
a. For intestinal tract
e. Some FA and TG but not predominate fuel sources
i. If there was no switch you would use up all your muscle and organs as a
source of fuel
1. Then death
ii. We stay in this state for 2-3 days
III. Adapted late starvation
a. Ketone and FA are main fuel source
i. Change in hormonal profile
ii. Further drop in insulin increases lipolysis (allows us to adapt)
1. Hydrolyze TG
a. Glycerol (rather than Lactate and Alanine)
i. Sparing your lean muscle! Breaking it down
2. FA to Acetyl CoA to make ketones
a. Energy source for the muscle and the brain
i. But brain can only use ketones and glucose but no FA
b. Ketones are imperative to provide fuel to brain
iii. Relative to early cortisol goes down (major converter of pyruvate to alanine)
b. You can survive as long as you have fat
c. Once the fats gone death can ensue but could be several months (using your body
fat as fuel source)
d. Ketones can be detrimental (pH decrease) but life sparing because they provide fuel
to the brain
e. Like a T1DM we have a deficit of insulin

i. Using FA to make ketone and glycerol backbone to make small amounts of

glucose
ii. Ongoing cause diabetic ketoacidosis
1. Glutamine goes to kidney and can help lower blood pH by combining
the amino group (glutamate and ammonia) take excess protons
contributing to acidosis and changed to ammonium and excreted
(increase blood pH)
iii. Can see in T2DM but much lesser extent (glycogen stores) ketone in urine...
f. Increase in glucagon and epinephrine
IV. Stress/Sepsis/Trauma
a. Looks like early but there is an increase in insulin
b. Acute phase proteins help with immune response and protein synthesis
c. Puts breaks on lipolysis (glucose is used) made by breaking down lean skeletal
tissue
d. Wound healing is higher priority
e. Some tissue become resistant to insulin
i. Muscel tries to do all this catabolic stuff starts reducing its compression of
GLUT transport
f. Increase in cytokines, glucagon, catecholamines, and cortisol
i. Can live in this state for a long time if an outside source is coming in
V. Polling Question #1
a. (B)
VI. Polling Question #2
a. (C)