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IMF-088-03-0001-en	What does branching give glycogen as a fuel store?	Branching creates many nonreducing ends, permitting simultaneous synthesis or degradation, and it increases solubility.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0002-en	How does insulin favour glycogen synthesis through the phosphorylation state of glycogen synthase?	Glycogen synthase is active when relatively dephosphorylated; insulin activates protein phosphatase pathways and inhibits kinases, and glucose six-phosphate further stimulates it allosterically.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0003-en	Why does glycogen phosphorylase use inorganic phosphate rather than water, and why is debranching enzyme needed?	Phosphorolysis releases glucose one-phosphate, conserving energy compared with hydrolysis; phosphorylase stops near branches, so debranching enzyme moves a short chain and hydrolyses the alpha one-to-six glucose.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0004-en	Glucagon does not act directly on skeletal muscle. How does contracting muscle still mobilise its glycogen?	Calcium released during contraction activates phosphorylase kinase through calmodulin, and epinephrine stimulates glycogenolysis through adrenergic pathways.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0005-en	How do muscle and liver phosphorylase differ in their allosteric responses?	Muscle phosphorylase tracks energy state, activated by adenosine monophosphate and restrained by adenosine triphosphate and glucose six-phosphate; liver phosphorylase responds to glucose, stopping breakdown after feeding.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0006-en	Why do hepatic and muscle glycogen-storage disorders present differently?	Impaired hepatic glucose release causes fasting hypoglycaemia and hepatomegaly, whereas muscle phosphorylase or glycolytic defects cause exercise intolerance, cramps, and rhabdomyolysis.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0007-en	What drives the oxidative phase of the pentose-phosphate pathway, and what does it produce?	Beginning with glucose-six-phosphate dehydrogenase, this irreversible phase accelerates when NADP plus is available and yields two NADPH, carbon dioxide, and ribulose five-phosphate.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0008-en	Why does glucose-six-phosphate-dehydrogenase deficiency cause episodic haemolysis?	Lacking mitochondria, erythrocytes rely on this pathway's NADPH to keep glutathione reduced for peroxide detoxification, so infection, drugs, or oxidant foods cause haemoglobin denaturation and membrane damage.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0009-en	How does NADPH protect cells from oxidants in erythrocytes yet generate oxidants in phagocytes?	Erythrocytes use it to keep glutathione reduced, whereas phagocyte NADPH oxidase transfers its electrons to oxygen to make superoxide inside the phagosome; oxidase defects cause chronic granulomatous disease.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0010-en	How does a cell needing NADPH more than ribose run the pentose-phosphate pathway?	It recycles pentoses through nonoxidative reactions into glycolytic intermediates and back toward glucose six-phosphate, permitting repeated oxidation with carbon lost as carbon dioxide.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0011-en	How does the source of blood glucose change from early to prolonged fasting, and how does brain adapt?	Hepatic glycogenolysis dominates early; as glycogen falls, gluconeogenesis powered by fatty-acid oxidation dominates and kidney contributes more, while brain gradually uses ketone bodies, reducing glucose and amino-acid demand.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0012-en	How can the polyol pathway injure tissues such as lens and peripheral nerve during hyperglycaemia?	Aldose reductase reduces glucose to sorbitol using NADPH; where sorbitol removal is limited this causes osmotic and redox stress, and NADPH consumption may compromise antioxidant capacity.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0013-en	Why can glycated haemoglobin misrepresent glucose exposure in some patients?	It integrates exposure over the erythrocyte lifespan, so altered red-cell turnover or haemoglobin variants change the result independently of glucose.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending
IMF-088-03-0014-en	Why must a metabolite concentration be distinguished from pathway flux in clinical interpretation?	A concentration can stay normal when production and consumption both accelerate, and an accumulated intermediate may reflect either increased formation or blocked disposal.	Integrated Medical Foundations; chapter 88, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 11b77b1f5292f83c89ab88dca7a5516e0a8cf596ed348139ad08fb949fe2105a; editorial review pending	imf lang::en chapter::088 module::088-03 review::pending