Diabetic patients may present with shock, but in non-insulin-dependent diabetes there may also be a defect in pyruvate oxidation, and in diabetic ketoacidosis ketones may also inhibit hepatic lactate uptake. Thiamine and biotin are essential co-factors for pyruvate dehydrogenase activity and for conversion of pyruvate to oxaloacetate.
During power exercises such as sprinting, when the rate of demand for energy is high, glucose is broken down and oxidized to pyruvate, and lactate is then produced from the pyruvate faster than the body can process it, causing lactate concentrations to rise.
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