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IMF-088-01-0001-en	Why do glycolysis and gluconeogenesis use distinct enzymes around their energetically favourable steps despite sharing reversible reactions?	Separate enzymes at those steps permit reciprocal control, so the cell avoids wasteful simultaneous cycling of glucose breakdown and synthesis.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0002-en	How does insulin change glucose uptake in skeletal muscle and adipose tissue, and how does brain uptake differ?	Insulin recruits glucose transporter four to muscle and adipose membranes, raising uptake, whereas brain uptake is largely insulin independent.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0003-en	Why does phosphorylation by hexokinase trap glucose inside the cell?	Glucose six-phosphate is a charged sugar phosphate, and charged sugar phosphates do not diffuse through the membrane.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0004-en	Which properties of hepatic glucokinase, compared with most hexokinases, let the liver buffer postprandial glucose?	It has lower affinity and higher capacity, is not directly inhibited by glucose six-phosphate, and is regulated by sequestration and insulin-dependent expression.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0005-en	How is phosphofructokinase one regulated so that glycolytic flux matches energy demand?	Adenosine monophosphate and fructose two, six-bisphosphate accelerate this committed step, while high adenosine triphosphate, citrate, and acidic conditions in muscle slow it.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0006-en	Which two glycolytic enzymes make adenosine triphosphate by substrate-level phosphorylation, and from what?	Phosphoglycerate kinase transfers a high-energy phosphate from one, three-bisphosphoglycerate, and pyruvate kinase uses the high phosphate-transfer potential of phosphoenolpyruvate.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0007-en	Why does glycolysis yield a net of only two adenosine triphosphates per glucose, and what else does it produce?	It consumes two adenosine triphosphates and produces four, and it also yields two NADH and two pyruvate.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0008-en	Glycolysis does not require oxygen. Why then does it depend on lactate dehydrogenase under anaerobic conditions?	Continued glycolysis requires regeneration of NAD plus; lactate dehydrogenase supplies it by oxidising NADH while reducing pyruvate to lactate.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0009-en	Why does a raised blood lactate not by itself prove tissue hypoxia?	Lactate rises whenever production exceeds utilisation, which also occurs with adrenergic acceleration, mitochondrial dysfunction, impaired clearance, drugs, seizures, or intense exercise.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0010-en	Which signals inhibit and which promote pyruvate dehydrogenase activity?	Product accumulation, phosphorylation by its regulatory kinase, high energy, and fatty-acid oxidation inhibit it; phosphatase activation, pyruvate, and energy demand promote it.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0011-en	How do pyruvate dehydrogenase defects and thiamine deficiency cause lactate accumulation and brain injury?	The complex requires thiamine pyrophosphate; loss of its activity diverts pyruvate toward lactate and alanine, particularly harming brain, and thiamine deficiency creates a functional block.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0012-en	Why can even-chain fatty acids support gluconeogenesis yet provide no net glucose carbon in humans?	They supply energy and acetyl coenzyme A, but pyruvate dehydrogenase is irreversible, so acetyl coenzyme A cannot be simply reversed into net glucose.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0013-en	Which carbon sources feed gluconeogenesis, and which organs perform it?	Lactate from the Cori cycle, alanine and other glucogenic amino acids, glycerol from lipolysis, and propionate; mainly liver, with kidney increasing in prolonged fasting.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0014-en	Why does acetyl coenzyme A activate pyruvate carboxylase, and how does the oxaloacetate formed reach the gluconeogenic pathway?	Acetyl coenzyme A signals abundant fatty-acid oxidation; oxaloacetate cannot cross the inner membrane, so it leaves as malate or aspartate or is converted to phosphoenolpyruvate in mitochondria.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0015-en	How does phosphoenolpyruvate carboxykinase make the difficult reversal of pyruvate kinase feasible?	It uses guanosine triphosphate to decarboxylate and phosphorylate oxaloacetate, and the decarboxylation helps drive formation of phosphoenolpyruvate.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0016-en	Why do the signals that accelerate phosphofructokinase one tend to suppress gluconeogenesis?	Fructose-one, six-bisphosphatase is inhibited by adenosine monophosphate and fructose two, six-bisphosphate and activated by citrate, the reverse of phosphofructokinase control.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0017-en	Why can liver and kidney release free glucose while muscle cannot?	Glucose-six-phosphatase in the endoplasmic reticulum of liver and kidney removes the phosphate; muscle lacks this enzyme and retains glucose six-phosphate for its own use.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0018-en	How does glucagon shift liver from glycolysis toward gluconeogenesis through fructose two, six-bisphosphate?	Through cyclic adenosine monophosphate and protein kinase A it phosphorylates the bifunctional enzyme, lowering fructose two, six-bisphosphate, slowing glycolysis and favouring gluconeogenesis.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0019-en	Why is hepatic pyruvate kinase inhibited during fasting?	Glucagon-dependent phosphorylation inhibits it, preventing newly formed phosphoenolpyruvate from being recycled back to pyruvate instead of proceeding toward glucose.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0020-en	Why does erythrocyte pyruvate-kinase deficiency cause haemolysis?	Loss of the enzyme reduces adenosine triphosphate production, impairing membrane maintenance in these glucose-dependent cells.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0021-en	What does the glucose–alanine cycle carry that the Cori cycle does not, and why do neither create free energy?	It moves amino nitrogen as well as carbon, which liver turns into urea; both cycles merely redistribute burden, as liver spends energy to make glucose.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0022-en	How can ethanol metabolism cause fasting hypoglycaemia with lactic acidosis?	Excess NADH shifts pyruvate toward lactate and oxaloacetate toward malate, suppressing gluconeogenesis.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0023-en	Why can high fructose intake produce less regulated glycolytic flux in liver?	Fructose enters glycolytic intermediates downstream of phosphofructokinase, bypassing that control point and supplying triose phosphate.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending
IMF-088-01-0024-en	How does renal gluconeogenesis in prolonged fasting link glucose production to acid–base balance?	Renal cortex produces glucose while excreting ammonium generated from glutamine, coupling gluconeogenesis to acid–base homeostasis.	Integrated Medical Foundations; chapter 88, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 4b11458449ea21c70569804baf3a8bfdf8e7a68879a34525bda348ede4c67620; editorial review pending	imf lang::en chapter::088 module::088-01 review::pending