As the attending physician in the ER you are treating a 29-year-old woman brought in by her husband. He tells you that she has complained of breathing difficulty and has been nauseous and vomiting for the past 4 hours. He also reports that she has been using insulin for the past 8 years to treat her Type 1 diabetes. She indicates that she has not given herself an injection of insulin for the past 24 hours. Her pulse is 100/min, and respirations are 30/min. Physical examination indicates lethargy, dehydration, and deep respirations. Blood work show hyperglycemia and metabolic acidosis. Which of the following best describes the current activity of the metabolic pathways in this woman liver?

Question

Quizplus · Accepted Answer

In diabetic ketoacidosis, insulin deficiency leads to increased gluconeogenesis and fatty acid oxidation, decreased glycogen synthesis, and decreased glycolysis in the liver.  Associated with insulin deficiency in Type 1 diabetes is uncontrolled glucagon secretion. In the absence of injected insulin in this patient, she will have exacerbated responses to the increased glucagon. These responses will include increased hepatic gluconeogenesis and increased glycogen breakdown. In addition, the rate of glucose oxidation will be reduced and fatty acid oxidation will be increased. All of these effects are exerted via glucagon-mediated increases in the activity of PKA.

As the Attending Physician in the ER You Are Treating