The 'ominous octad' of insulin resistance involves eight distinct problems within the muscle, suggesting a single drug is unlikely to correct all issues.

“so what was the trium rate was very simple the beta cell it fails insulin resistance in the muscle when you uh ingested a meal the muscle didn't take up the glucose cuz you're insulin resistant and insulin resistance in the liver when you ate a meal insulin didn't shut down uh the liver so that was the Triumph rate so from the Triumph rate to the ominous octet we needed to add five more players so who were the new five players uh so number four on the list was the fat cell”