Expanding fat cells become resistant to insulin's anti-lipolytic effects, leading to increased fat release and metabolic dysfunction.

“a very common phenotype of insulin resistance is adiposity obesity rat meaning obesity which of course means the accumulation of fat in a fat cell so if that cell is getting bigger well for fat cell to get larger it needs to incorporate triglyceride to incorporate triglyceride requires insulin and to keep insulin in the fat cell requires insulin to prevent lipolysis and so on the one hand you say well this patient is insulin resistant we'll talk about which cells you know maybe the muscle is insulin resistant but at the very least looking at the fat cell it appears to be quite well and sensitive to insulin right exactly”

“if you brought them down to normal levels of insulin then you might see more lipolysis”

“what insulin does in the fat cell is that puts the brake on break down a fat it's called that lipolysis or take up glucose to esterify fatty acids into glucose”

“obviously insulin plays you know along with maybe hormone sensitive lipase the most important role in determining the rate of esterification versus lipolysis in the fat cell uh and obviously we know the role insulin plays for glucose into the muscle cell obviously there is also non-insulin dependent glucose uptake but where does insulin if at all factor into the both the athlete and the diabetic with respect to how uh fat is getting into and out of the muscle or into the muscle and then oxidized”

“if you keep expanding those fat cells the fat cells become very very resistant to the anti- lipoic effects of insulin and now you start to pour fat out into the bloodstream”

“but in obese people insulin doesn't work so well so instead of keeping the fat in the fat cell even though your insulin is high you're breaking down the fat”

“It becomes insulin resistant, which is manifested as insulin not being able to inhibit lipolysis. Now, we have a metabolic millu that's quite odd, where you have high insulin and high free fatty acids. That does not happen unless the fat cells are insulin resistant.”

“So in other words, the fat cell knows what to do with the energy that it has access to. A cell doesn't have any kind of intuitive intellect to think, okay, there's calories here, or more accurately, carbons that I can turn into triglycerides, and I'm going to take them in and store them. But in the context of the body, the fat cell needs to know, am”