“…Insulin resistance arises when insulin-responsive tissues like skeletal muscle, fat, and myocardium exhibit reduced sensitivity to insulin (Park et al, 2023;Kalmykova, & Kalmykov, 2023) or down regulate insulin receptors in response to hyper-insulinemia (Dionysopoulou et al, 2021,). On insulin sensitivity testing, insulin resistance manifests as: elevated fasting insulin/glucose, higher glycosylated hemoglobin (HbA1c), postprandial hyperglycemia, hyperlipidemia, poor glucose/insulin tolerance, reduced glucose infusion rates, increased hepatic glucose output, absent initial insulin secretion, and high levels of circulating inflammatory markers (Milano et al, 2022).…”