Managing hyperglycemia and hyperinsulinemia is crucial when using PI3K inhibitors that target the alpha isoform.

“what happens is that the body mounts an insulin emic response to the drug that insulin emic response goes to the cancer and starts feeding the cancer and then the cancer becomes resistant so you essentially undo all the good that you've done with the drug by cutting off your own limb because of this entry circuit”

“what if the drug was causing diabetes separately from the tumor given to normal people that the drug would cause diabetes in some people worse than others and that diabetic phenotype a diabetic state the hyperinsulinemic state was being used or exploited by the tumor to essentially become resistant to the drug”

“But that's the one that's going to need the most management of the hyperglycemia and the hyperinsulinemia.”