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Fig. 2 | BMC Sports Science, Medicine and Rehabilitation

Fig. 2

From: Exercise as ‘precision medicine’ for insulin resistance and its progression to type 2 diabetes: a research review

Fig. 2

The metabolic inflexibility of type 2 diabetes. Metabolic flexibility is often quantified as the change in non-protein respiratory exchange ratio between metabolic extremes; for example, the fasting state and the metabolic milieu created by supraphysiological insulin stimulation during a hyperinsulinemic euglycemic clamp. In their study, van de Weijer et al. confirmed that subjects with type 2 diabetes demonstrate a higher NPRER (less lipid use) during fasting (open bars) and a lower NPRER (less carbohydrate use) during maximal insulin stimulation (closed bars) [83]. Consequently, these patients demonstrate metabolic inflexibility (reduced ΔNPRERclamp-fast; grey bars) compared to their non-diseased counterparts

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