The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
only when you get to very high doses of insulin do you get the glucose effects and this is this is documented in the science that we and this is probably this is what happens when we are thinking about this from the perspective of the the you glycemic hyperinsulinemic clamp studies which are what are used to look at insulin sensitivity we are only giving people doses of insulin that are high enough to get to that fifth function
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so I think about insulin as it tours through the body a lie where does it if it's produced normally in the pancreas where does it go first and then what does it do and in that order so in you know as soon as Reis in the pancreas it acts to inhibit the release of glucose glucagon as long as the pancreas is insulin sensitive include gone obviously being part of the signal telling you to break down tissue inactivate glucan gluconeogenesis in the liver and so it first it does that it suppresses glucagon secretion and then it goes to the liver where it alters turns gluconeogenesis on and off you know are you you know needing to make more glucose or less and obviously if you're in a ketogenic state you will need more gluconeogenesis and there is some some evidence for that because you're not getting that carbohydrate in the diet and so insulin is low more gluconeogenesis and then it goes out into the circulation and the first thing that it does is to suppress or be anti catabolic in the muscle tissue and the adipose tissue so when you they've done my studies where you basically inject insulin into like one limb and then you look at the amount of a substrate coming in and coming out so at the lower doses of insulin you reduce circulating fatty acids so for the first thing that it does is be anti catabolic in the in the adipose tissue or start to cause the uptake of fatty acids from the circulation and then to actually enter start finally shoving glucose into cells you need you need to increase the dose yet again
as you and i talked about there are multiple roles of insulin and this was your sort of paradigm that the first role of insulin was an autocrine effect in the pancreas sort of limiting glucose so let's just why don't you just give people sort of your perspective on the higher some sort of hierarchy what are the roles of insulin and where does pushing glucose into cells fall in that hierarchy yeah so so it does do that once the dose once the level is high enough and so i think about insulin as it tours through the body like where does it if it's produced normally in the pancreas where does it go first and then what does it do and in that order so in you know as soon as it's released in the pancreas it acts to inhibit the release of glu of glucagon as long as the pancreas is insulin sensitive and glucon obviously being part of the signal telling you to break down tissue and activate gluconeogenesis in the liver and so it first it does that suppresses glucagon secretion um and then it goes to the liver where it alters uh turns gluconeogenesis on and off you know are you um you know needing to make more glucose or less and obviously if you're in a ketogenic state you will need more gluconeogenesis and there is some some evidence for that because you're not getting that carbohydrate in the diet and so insulin is low more gluconeogenesis and then it goes out into the circulation um and the first thing that it does is to suppress or be anti-catabolic in the muscle tissue and the adipose tissue so when you um they've done nice studies where you basically uh inject insulin into like one limb and then you look at the amount of a substrate coming in and coming out so with the lower doses of insulin um you reduce uh circulating fatty acids so the first thing that it does is be anti-catabolic in the adipose tissue or start to cause the uptake of of fatty acids from the circulation and then to actually then to start finally shoving glucose into cells you need you need to to increase the dose yet again so of all the things that insulin does requiring the highest circulating amount the final thing is is glucose uptake into
insulin does basically a couple of things it tells the liver hey stop making glucose because if the liver was still making glucose you would now have a very high level of blood glucose which we never want and it tells the muscle take glucose in the muscle is the predominant place where we dispose of glucose