Figure 5.

In some patients at risk for type 2 diabetes, liver insulin degradation has been shown to be suppressed (e.g., in AAs). Thus, a larger fraction of the secreted insulin reaches the systemic circulation. Hyperinsulinemia may then result in insulin resistance at muscle, stressing the β-cells, and at adipose tissue, resulting in lipolysis and inappropriately increased endogenous glucose production. Adapted with permission from Bergman et al. (48).