Figure 2

Effect of alternative insulin-independent pathway. Glucose concentration x _G as a function of the increase r in a substance a which opens an alternative insulin-independent pathway for glucose absorption (by the cells which are relevant in the present context). The top and middle curves are respectively for c _a  = 1 and 2, where c _a is the strength of this alternative pathway relative to the normal insulin-dependent pathway in a patient with strong insulin resistance. The bottom curve represents the limit of extreme insulin resistance. The scaled product glucose × insulin is given by exactly these same curves, since the insulin level is constant in this case. If the present mechanism and that of Figure1 are both operative, there is, of course, an even larger drop in glucose level, and also a substantial drop in glucose × insulin. This product, in a postprandial state, is a measure of insulin resistance analogous to HOMA-IR – which is the same product measured in the fasting state.