If you consider another pathway such as gluconeogenesis, or the creation of sugar from amino acids and glycerol (a backbone molecule in fats), the inability to have access to the fat backbone, glycerol can lead to hypoglycemia. Carnitine helps in the process of breaking down large chain fatty acids. No carnitine, no glycerol, no gluconeogenesis. read more
In secondary carnitine deficiency, which is caused by other metabolic disorders (eg, fatty acid oxidation disorders, organic acidemias), carnitine depletion may be secondary to the formation of acylcarnitine adducts and the inhibition of carnitine transport in renal cells by acylcarnitines. read more
Carnitine acyl transferase is not the right answer, because if there was such, it would result in no fatty acid degradation at all and the clinical consequence is much severe. Fatty acids are not able to enter the mit matrix. read more