Insulin Resistance and a Long, Strange Trip

“What a long, strange trip it’s been” is how the late Jerry Garcia and the Grateful Dead reflected on the ups and downs of life in a famous song. Clinicians might use the same phrase to describe the search for ways to treat insulin resistance, which is very common. Insulin binds to its receptor to activate intracellular signaling that regulates nutrient metabolism, growth, fluid homeostasis, blood-vessel tone, and other functions. When confronted with excess adiposity, cells dampen insulin-receptor signaling to resist the effects of insulin. This impaired signaling elevates lipids through a lack of suppression of fatty acid release by . . .