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DR. RAJENDRAN’S INSTITUTE OF MEDICAL EDUCATION

Phone 0470 – 2604199, 09388852220.

DM – Overview of metabolism
Diet – Energy from carbohydrates, fats, and proteins.

ATP is the ‘Energy currency’. ATP transfer free energy from substances of high energy to
substances of low energy.

Mitochondria is the powerhouse of the cell. Oxidative phosphorylation couples respiration to

generation of ATP.

Oxidation is loss of electrons. Reduction is gain of electrons. Both are always combined.

Cyanide inhibits oxidative phosphorylation.

Carbohydrate metabolism

Glucose is the most important carbohydrate. All carbohydrates are converted to glucose.
Glucose absorbed from intestine enters portal vein and go to the liver.

Glucose in liver

1 Used for liver metabolism

2 Stored as glycogen (Glycogen is storage form of glucose)

3 Released into blood as glucose

4 Excess glucose converted to fat and stored in adipose tissue as triglycerides.

Major source of carbohydrates is plants

CHO, fat, protein – common metabolite is acetyl CoA.

Acetyl CoA is the common metabolic product of metabolism of CHO, fat and protein. Contains
pantothenic acid. It enters citric acid cycle and generates ATP.

Glycolysis

Aerobic

Glucose Pyruvate Acetyl CoA Citric acid cycle 38

molecules of ATP
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Anaerobic - Glucose Lactate. Provides ATP in the absence of Oxygen (but only 2
ATP molecules)

Glucose in muscle

Glycogen ↔ Glucose CO2 + Lactate Converted to glucose in liver

Citric acid cycle (Kreb’s cycle)

Final common pathway for metabolism of CHO, fats and proteins.

H2o + Acetyl CoA Co2 + (2H) Respiratory chain. Generates 12 high energy phosphate
bonds per turn of the cycle.

The 4 vitamins in citric acid cycle are riboflavin, niacin, thiamine, and pantothenic acid.

Gluconeogenesis

Convert non-carbohydrates into glucose.

Substrates are amino acids (from breakdown of muscle proteins), lactate (from breakdown of
glucose in muscle), and glycerol (from adipose tissue).

Lipid metabolism
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Fats have high energy value. Fat is stored in adipose tissue as triglycerides (FA + glycerol).

Fats are insoluble in water. They are transported bound to proteins (lipoproteins = fats +
proteins).

Main substrate for synthesis is glucose.

Beta oxidation (inside mitochondria) ketone bodies

FA Acetyl CoA Citric acid cycle

APT generated ATP generated

Ketone bodies formed in the liver when there is high rate of beta oxidation.

FFA cannot pass though inner mitochondrial membrane. Transported by carnitine palmitoyl
transport system into the mitochondria for beta oxidation.
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Chylomicrons are formed by the lymphatic system draining the intestine. They transport all
dietary lipids into the blood. 80% of chylomicrons are metabolized by adipose tissue, heart and
muscles. 20% of chylomicrons are metabolized by the liver. Chylomicrons contain 88%
triglycerides

VLDL (Pre-beta lipoproteins) are produced in the liver for export of triglycerides. LDL is the final
stage of catabolism of VLDL. HDL is involved in metabolism of chylomicrons and LDL. The
predominant lipid in HDL is phospholipid.

Lipoprotein lipase present in endothelium of caplillaries (not active in blood and liver).
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Protein metabolism

Integration of metabolism

When there is positive caloric balance, food is stored as glycogen and triglycerides.

During starvation, fat is oxidized in preference to glucose. Brain and RBCs always need
glucose.
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