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IMF-089-03-0001-en	How is blood glucose maintained early in an overnight fast while glucose is also spared?	Liver glycogen supplies much glucose as gluconeogenesis rises; falling insulin and rising glucagon permit lipolysis, so muscle and liver oxidise more fat, while glycerol, lactate and alanine feed gluconeogenesis.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0002-en	Why does rising ketone availability protect muscle protein during prolonged fasting?	Ketones let the brain reduce glucose use, lowering the need to convert muscle protein into glucose, since sustained protein loss would be incompatible with survival.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0003-en	Why does hepatic ketogenesis accelerate when fatty-acid oxidation is high?	Oxaloacetate is diverted to gluconeogenesis and high NADH slows cycle reactions, so acetyl-CoA exceeds citric-acid-cycle capacity and is routed via HMG-CoA synthase and lyase to acetoacetate.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0004-en	Why does the liver export ketone bodies but cannot use them?	It lacks succinyl-CoA:acetoacetate CoA-transferase (thiophorase), which extrahepatic mitochondria use to activate acetoacetate with succinyl-CoA before splitting it into two acetyl units for oxidation.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0005-en	What distinguishes physiological nutritional ketosis from ketoacidosis?	In nutritional ketosis, preserved insulin restrains runaway lipolysis so ketonaemia stays limited and pH is regulated; ketoacidosis arises when production overwhelms utilisation and buffering amid hormonal dysregulation.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0006-en	How does severe insulin deficiency drive ketogenesis in diabetic ketoacidosis?	With excess glucagon and stress hormones, adipose lipolysis floods the liver with fatty acids, malonyl-CoA falls, and mitochondrial fatty-acid entry and ketogenesis accelerate.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0007-en	Why is total-body potassium depleted in diabetic ketoacidosis even when serum potassium is normal or high?	Osmotic diuresis causes electrolyte loss, while insulin deficiency, acidosis and hyperosmolality shift potassium out of cells, so the serum value hides the depletion.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0008-en	Why is glucose added during treatment of diabetic ketoacidosis once blood glucose falls?	Insulin is given to stop ketogenesis, and ketones are still being cleared after glucose falls, so glucose is added to let insulin continue.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0009-en	Why does alcoholic ketoacidosis favour beta-hydroxybutyrate, and why is dextrose given with thiamine?	Ethanol-induced high NADH, with low glycogen, low insulin and lipolysis, favours beta-hydroxybutyrate; dextrose stimulates insulin, and thiamine is given before or with carbohydrate in at-risk patients.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0010-en	Why can urine nitroprusside testing mislead both in severe ketoacidosis and during recovery?	It detects acetoacetate more than beta-hydroxybutyrate; high NADH in severe illness shifts the pool to beta-hydroxybutyrate, underestimating severity, and reconversion during recovery keeps urine ketones high despite improvement.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0011-en	Why is refeeding after severe deprivation dangerous even though food is not a toxin?	The metabolic transition triggers insulin-driven shifts of phosphate, potassium and magnesium and raises thiamine demand; severe hypophosphataemia impairs heart, respiratory muscle, blood cells and nervous system.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0012-en	How can insulin resistance worsen hepatic steatosis when insulin normally promotes lipogenesis?	Insulin resistance can increase fatty-acid delivery from adipose tissue while hepatic lipogenesis remains insulin responsive, so uptake plus synthesis exceed oxidation plus lipoprotein export.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0013-en	What distinguishes adrenoleukodystrophy from Zellweger-spectrum disorders at the peroxisome?	Adrenoleukodystrophy impairs peroxisomal transport of very-long-chain fatty acids, whereas Zellweger-spectrum disorders impair peroxisome assembly and so disrupt multiple pathways, causing severe multisystem disease.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending
IMF-089-03-0014-en	Why is pharmacological activation of brown and beige fat challenging?	These tissues dissipate energy as heat through uncoupling protein 1 under sympathetic stimulation, but systemic adrenergic effects and compensatory appetite can offset the added expenditure.	Integrated Medical Foundations; chapter 89, TTS module 3; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c27c2518ed59889d7b6db47416fdc3ffedd7ca55f06e722530a5bf1d69224cbc; editorial review pending	imf lang::en chapter::089 module::089-03 review::pending