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The pancreas secretes two kinds of hormones: 1. Digestive enzymes - these help break down carbohydrates, fats, and proteins into simple “building blocks” that give cells energy. 2. Insulin - the amount insulin produced by the pancreas regulates the glucose levels in the body.
What happens when the pancreas doesn t produce enough insulin?
If your pancreas doesn’t make enough insulin or doesn’t make good use of it, glucose builds up in your bloodstream, leaving your cells starved for energy. When glucose builds up in your bloodstream, this is known as hyperglycemia. The symptoms of hyperglycemia include thirst, nausea, and shortness of breath.
What does the pancreas secrete to raise glucose level?
- Glucagon – produced in alpha (α) cells, increases glucose in the blood
- Insulin – produced in beta (β) cells, decreases glucose in the blood
- Somatostatin – produced in delta (δ) cells, regulates the activity of alpha and beta cells
- Pancreatic polypeptide – produced in gamma (γ or PP) cells.
Can your pancreas produce too much insulin?
Insulin resistance can lead to type 2 diabetes. Beside this, what causes overproduction of insulin? A rare tumor of the pancreas (insulinoma) can cause you to produce too much insulin, resulting in hypoglycemia. Other tumors also can result in too much production of insulin-like substances.
Why is insulin only produced in the pancreas?
Insulin is a hormone that is produced by beta cells in the pancreas of our body. These beta cells manufacture and release the insulin in our blood so that it may circulate and allow glucose to enter and fuel the cell. As such, when insulin enters the cells, the remaining supply of glucose in our blood decreases.
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How insulin is secreted?
Insulin secretion involves a sequence of events in β-cells that lead to fusion of secretory granules with the plasma membrane. Insulin is secreted primarily in response to glucose, while other nutrients such as free fatty acids and amino acids can augment glucose-induced insulin secretion.
How does the pancreas control insulin?
Beta cells in the pancreas produce insulin and release it into the bloodstream after people eat. Insulin enables body cells — such as muscle, fat, and heart cells — to absorb the sugar from food and use it for energy and other essential processes.
How does the pancreas secrete glucose?
Maintenance of blood glucose levels by glucagon and insulin. When blood glucose levels are low, the pancreas secretes glucagon, which increases endogenous blood glucose levels through glycogenolysis.
Can pancreas start producing insulin again?
Researchers have discovered that patients with type 1 diabetes can regain the ability to produce insulin. They showed that insulin-producing cells can recover outside the body. Hand-picked beta cells from the islets of Langerhans in the pancreas.
Can you live without your pancreas?
It's possible to live without a pancreas. But when the entire pancreas is removed, people are left without the cells that make insulin and other hormones that help maintain safe blood sugar levels. These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots.
Where is insulin produced in the pancreas?
There are specialised areas within the pancreas called islets of Langerhans (the term insulin comes from the Latin insula that means island). The islets of Langerhans are made up of different type of cells that make hormones, the commonest ones are the beta cells, which produce insulin.
How much insulin does the pancreas produce daily?
The pancreas of a normal adult contains approximately 200 units of insulin, and the average daily secretion of insulin into the circulation in healthy individuals ranges from 30 to 50 units.
Which cells of pancreas produce insulin?
When blood glucose levels rise, beta cells in the pancreas normally make the hormone insulin.
How does pancreas regulate the amount of blood sugar?
The pancreas releases glucagon when glucose levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream. High BG levels stimulate the release of insulin. Insulin allows glucose to be taken up and used by insulin-dependent tissues, such as muscle cells.
What happens to pancreas in type 2 diabetes?
In type 2 diabetes, the pancreas makes insulin, but the cells don't respond to it as they should. This is called insulin resistance. When glucose can't get into cells, the blood sugar level rises. Then the pancreas works harder to make even more insulin.
How can I keep my pancreas healthy to prevent diabetes?
To get your pancreas healthy, focus on foods that are rich in protein, low in animal fats, and contain antioxidants. Try lean meats, beans and lentils, clear soups, and dairy alternatives (such as flax milk and almond milk). Your pancreas won't have to work as hard to process these.
How much insulin does the pancreas produce daily?
The pancreas of a normal adult contains approximately 200 units of insulin, and the average daily secretion of insulin into the circulation in healthy individuals ranges from 30 to 50 units.
What is the function of the pancreas?
Located in the upper abdomen behind the stomach, it has two important functions: It produces. enzymes that break down foods in the intestine, as well as. hormones that regulate blood sugar levels. Position of the pancreas.
What hormone is released when blood sugar is low?
When blood sugar levels are too low, the pancreas releases glucagon into the bloodstream. This hormone does the opposite of what insulin does: It causes the liver cells to release stored sugar. It also makes sure that proteins in the liver are turned into sugar that can then be used for energy.
How many liters of water does an exocrine cell produce?
The exocrine cells produce digestive juices – about 1.5 to 2 liters per day. They are called exocrine ("secreting outside") because the digestive juices that they produce flow out into the small intestine rather than directly into the bloodstream. This clear, colorless fluid is mainly made up of water and also contains salt, sodium bicarbonate and digestive enzymes. There are three main types of enzymes:
What muscle controls the release of digestive juices into the small intestine?
There is a circular muscle (sphincter) at the shared opening of the two ducts. This muscle controls the release of the digestive juices into the small intestine. The digestive juices usually only start working once they enter the small intestine. But if the pancreas is inflamed (pancreatitis), they already become active in the pancreas.
Why are endocrine cells called islets?
These groups of cells produce insulin, glucagon and other hormones. They are called endocrine ("secreting internally") cells because the hormones that they produce are secreted directly into the blood. These hormones usually help to regulate blood sugar levels, stopping them from getting too high or too low.
What hormone is released after a meal?
When the blood sugar levels rise, as they do after a meal, insulin is released by the islets of Langerhans. This hormone helps sugar to be absorbed from the bloodstream into the cells of the body. Insulin also allows the liver and the muscles to store sugar, as well as keeping the liver from producing more sugar.
Where do enzymes come from?
There are three main types of enzymes: The digestive juices that are made in the pancreas flow into the small intestine through a tube known as the pancreatic duct. In most people, this duct is joined by a similar duct coming from the gallbladder (the bile duct) before it reaches the small intestine.
Which cells secrete insulin?
The islets of Langerhans contain alpha cells which secrete glucagon and beta cells which secrete insulin. Insulin and glucagon are hormones that work to regulate the level of sugar (glucose) in the body to keep it within a healthy range. Unlike the acinar cells, the islets of Langerhans do not have ducts and secrete insulin ...
How does insulin work?
Insulin works by improving the uptake of glucose from the blood across cell membranes and into the cells of the body, and so takes glucose out of the bloodstream. Once in the cells, the glucose is used as the energy to fuel the cells doing their different jobs or is stored in the liver or muscle cells as glycogen.
What is the function of glucagon in the liver?
Glucagon signals the liver to break down glycogen into glucose; The liver releases glucose into the bloodstream; Blood glucose goes up to its normal set point; and. The pancreas detects the rise in blood sugar and switches off glucagon release.
What is the role of glucagon in the body?
The role of glucagon is to break down glycogen (the stored form of glucose) in the liver. Then the liver releases glucose into the bloodstream. This results in a rise in the blood glucose level to bring it back to a healthy level, which in turn signals the pancreas to switch off glucagon release.
How does glucagon work?
How glucagon works. Glucagon has an opposite (antagonistic) effect to insulin. When your blood glucose level falls, for example during exercise when your muscles are using glucose for fuel, your pancreas detects the drop in blood glucose. This prompts the pancreas to slow down the secretion of insulin, but increase the output of glucagon.
What is the function of the pancreas?
It lies in your abdomen, behind your stomach. It is a long thin structure with 2 main functions: producing digestive enzymes to break down food; and. producing the hormones insulin and glucagon to control sugar levels in your body.
Which organs detect the rise of blood glucose?
The pancreas detects the rise; The pancreas pumps out insulin into the blood; Insulin helps the uptake of glucose into muscles and other cells; This causes the blood glucose level to fall to its normal set point; and. The pancreas detects the fall and switches off insulin production.
How does the pancreas regulate glucose?
In a healthy person Normally, the pancreas makes enough insulin to keep the supply and use of glucose in balance. When the blood contains enough insulin, the liver temporarily shuts down its production of glucose, and glucose is transported from the blood into your cells. Cells use some of the glucose immediately. Most of the remainder is converted to a substance called glycogen in the liver and muscles, where it is stored for future use. The body's ability to store glycogen is limited, and any excess glucose that does not get stored as glycogen is converted to triglycerides and stored in adipose (fat) tissue. Pancreatic cells in the islets of Langerhans continuously monitor blood glucose levels. After a meal, the carbohydrates you eat are digested and broken down into glucose and other sugars, which pass into the bloodstream. As your blood glucose levels rise, beta cells in the pancreas respond by secreting insulin into the blood. Glucose then passes into your cells and the liver shuts down glucose production. Between meals, insulin also prevents excessive release of glucose from the liver into the bloodstream. If blood glucose levels drop too low between meals, alpha cells in the pancreas release a hormone called glucagon. This hormone signals the liver to convert amino acids and glycogen into glucose that is sent into the blood. In a person with diabetes In diabetes, this glucose balancing system is disrupted, either because too little insulin is produced or because the body's cells do not respond to insulin normally (a condition called insulin resistance). The result is an unhealthy rise in blood glucose levels. If diabetes is left untreated, the two principal dangers are the immediate results of high blood glucose levels (which include excessive urination, dehydrat Continue reading >>
How Does Your Body Know When To Secrete Insulin?
Your body needs insulin to absorb nutrients from your food. After you eat, your food goes through your digestive system so your body can absorb the nutrients from the glucose, fatty acids and amino acids within your food. Once these substances make it into your intestines, they act as a trigger for your body to start secreting insulin . What's really happening is that they stimulate your pancreatic islets' beta cells. The insulin levels in your blood begin to rise, which allows your body to now absorb the glucose, fatty acids and amino acids. Almost every cell in your body needs insulin, but it works mostly on the liver, fat and muscle cells. Insulin stimulates your liver and muscle cells to store glucose, while also inhibiting your liver and kidneys from making glucose. It also stimulates your liver and muscle cells to make needed proteins from amino acids. Lastly, insulin helps fat cells form fat. For people with type I diabetes, the body's pancreas has no beta cells, thus no means to secrete insulin. The pancreatic islets' beta cells could have been destroyed by the immune system, or by genetic or environmental factors. People with type 2 diabetes can secrete insulin, but their bodies don't process it well. As a result, Type 2 diabetics generally have too much insulin in their blood, which leads to insulin resistance. Gestational diabetes is similar to Type 2 diabetes and also leads to higher than normal levels of insulin in your blood. Only pregnant women are susceptible to gestational diabetes, which is thought to occur because hormones present during pregnancy can the woman’s body from properly using it Continue reading >>
How does insulin affect blood glucose levels?
Between meals, insulin also prevents excessive release of glucose from the liver into the bloodstream.
What happens when the pancreas is activated?
In case of pancreatitis, enzymes may be activated inside the pancreas before reaching the small intestine, causing the gland to start "digesting itself.". Endocrine pancreas cells Groups of endocrine cells are spread over the surface of the pancreas.
How big is the pancreas?
The pancreas is 12 to 18 centimeters (about 4.7 to 7.1 inches) long and weighs about 70 to 100 grams. The pancreas is made up of a head, a body and a pointy tail. It is located in the upper abdomen behind the stomach. The organ has two major functions. It produces Hormones and enzymes are produced in two different groups of cells: Exocrine pancreas cells Over 99% of the exocrine pancreas cells produce digestive juices – about 1.5 to 2 liters per day. They are called exocrine ("secreting externally") because they secrete digestive juice "externally" into the small intestine. This clear, colorless juice is mainly made up of water and also contains salt, sodium bicarbonate and digestive enzymes. There are enzymes for breaking down fats (lipases), proteins (proteases), and carbohydrates (amylases). Proteases are inactive while inside the pancreas. They are activated once they have been secreted into the small intestine. The sodium bicarbonate neutralizes the acidic gastric (stomach) juice in the mass of semi-digested food to help the digestive enzymes work better. The digestive juices flows from the pancreas through an excretory duct into the small intestine. In most people, this duct joins up with the the excretory duct of the gallbladder before reaching the small intestine. A sphincter muscle at the end of the duct controls the flow of digestive juice into the small intestine. In case of pancreatitis, enzymes may be activated inside the pancreas before reaching the small intestine, causing the gland to start "digesting itself." Endocrine pancreas cells Groups of endocrine cells are spread over the surface of the pancreas. They are called islets of Langerhans, because they are scattered like small islands and were discovered by pathologist Paul Langerhans. These islet ce Continue reading >>
Why does insulin need to open?
Think of insulin as a lock to the cell. Insulin must open the cell to allow it to use glucose for energy. If your pancreas doesn’t make enough insulin or doesn’t make good use of it, glucose builds up in your bloodstream, leaving your cells starved for energy.
What causes the pancreas to not produce insulin?
Type 1 diabetes In type 1 diabetes the immune system erroneously attacks the beta cells that produce insulin in your pancreas. It causes permanent damage, leaving your pancreas unable to produce insulin. Exactly what triggers the immune system to do that isn’t clear. Genetic and environmental factors may play a role.
Where Does Insulin Come From?
I mean the stuff given to inject yourself. I've been told it's from pigs. Is that true? The first successful insulin preparations came from cows (and later pigs). The pancreatic islets and the insulin protein contained within them were isolated from animals slaughtered for food in a similar but more complex fashion than was used by our doctor and med-student duo. The bovine (cow) and porcine (pig) insulin were purified, bottled, and sold. Bovine and porcine insulin worked very well (and still do!) for the vast majority of patients, but some could develop an allergy or other types of reactions to the foreign protein (a foreign protein is a protein which is not native to humans). In the 1980's technology had advanced to the point where we could make human insulin. The advantage would be that human insulin would have a much lower chance of inducing a reaction because it is not a foreign protein (all humans have the exact same insulin, so we do not "see" this as a foreign protein). The technology which made this approach possible was the development of recombinant DNA techniques. In simple terms, the human gene which codes for the insulin protein was cloned (copied) and then put inside of bacteria. A number of tricks were performed on this gene to make the bacteria want to use it to constantly make insulin. Big vats of bacteria now make tons of human insulin. From this, pharmaceutical companies can isolate pure human insulin. There are currently 3 Types of Insulin available in the UK. Then within each type there are a variety of insulin’s, which differ in the way they act and/or how long they last. Genetically Modified Continue reading >>
What is the function of the pancreas?
Functioning as an exocrine gland, the pancreas excretes enzymes to break down the proteins, lipids, carbohydrates, and nucleic acids in food. Functioning as an endocrine gland, the pancreas secretes the hormones insulin and glucagon to control blood sugar levels throughout the day. Both of these diverse functions are vital to the body’s survival. Continue Scrolling To Read More Below... Click To View Large Image Related Anatomy: Body of Pancreas Common Bile Duct Head of Pancreas Kidneys Neck of Pancreas Pancreatic Notch Small Intestine Tail of Pancreas Continued From Above... Anatomy of the Pancreas The pancreas is a narrow, 6-inch long gland that lies posterior and inferior to the stomach on the left side of the abdominal cavity. The pancreas extends laterally and superiorly across the abdomen from the curve of the duodenum to the spleen. The head of the pancreas, which connects to the duodenum, is the widest and most medial region of the organ. Extending laterally toward the left, the pancreas narrows slightly to form the body of the pancreas. The tail of the pancreas extends from the body as a narrow, tapered region on the left side of the abdominal cavity near the spleen. Glandular tissue that makes up the pancreas gives it a loose, lumpy structure. The glandular tissue surrounds many small ducts that drain into the central pancreatic duct. The pancreatic duct carries the digestive enzymes produced by endocrine cells to the duodenum. The pancreas is classified as a heterocrine gland because it contains both endocrine and exocrine glandular tissue. The exocrine tissue makes up about 99% of the pancrea Continue reading >>
What Is Insulin?
Insulin is a hormone; a chemical messenger produced in one part of the body to have an action on another. It is a protein responsible for regulating blood glucose levels as part of metabolism. 1 The body manufactures insulin in the pancreas, and the hormone is secreted by its beta cells, primarily in response to glucose.1 The beta cells of the pancreas are perfectly designed "fuel sensors" stimulated by glucose.2 As glucose levels rise in the plasma of the blood, uptake and metabolism by the pancreas beta cells are enhanced, leading to insulin secretion.1 Insulin has two modes of action on the body - an excitatory one and an inhibitory one:3 Insulin stimulates glucose uptake and lipid synthesis It inhibits the breakdown of lipids, proteins and glycogen, and inhibits the glucose pathway (gluconeogenesis) and production of ketone bodies (ketogenesis). What is the pancreas? The pancreas is the organ responsible for controlling sugar levels. It is part of the digestive system and located in the abdomen, behind the stomach and next to the duodenum - the first part of the small intestine.4 The pancreas has two main functional components:4,5 Exocrine cells - cells that release digestive enzymes into the gut via the pancreatic duct The endocrine pancreas - islands of cells known as the islets of Langerhans within the "sea" of exocrine tissue; islets release hormones such as insulin and glucagon into the blood to control blood sugar levels. Islets are highly vascularized (supplied by blood vessels) and specialized to monitor nutrients in the blood.2 The alpha cells of the islets secrete glucagon while the beta cells - the most abundant of the islet cells - release insulin.5 The release of insulin in response to elevated glucose has two phases - a first around 5-10 minutes after g Continue reading >>
What is the pancreas? What function does it serve?
Pancreas Tucked away inside your abdomen is an organ that is important to blood sugar regulation, called the pancreas. Though you do not always hear about the pancreas unless a problem arises, you will see from this lesson that it plays a key role in maintaining your body's homeostasis. In fact, both your digestive system and endocrine system count on the pancreas to carry out vital functions. Your pancreas is about six inches long and sits deep in your abdomen, partly behind your stomach. The pancreas is somewhat triangular in shape, and its broad end comes up against the first section of the small intestine that we previously learned is called the duodenum. This is a unique gland because it is both an endocrine gland and an exocrine gland. As we previously learned, what makes a gland endocrine or exocrine depends on how it secretes the product it produces. For example, an endocrine gland secretes hormones directly into the blood. In contrast, an exocrine gland secretes a substance through a duct. In the case of your pancreas, we see that it can be considered an exocrine gland because it secretes digestive juices into the duodenum through the pancreatic duct, as seen in this picture: Now, when we study the digestive system, we see that the pancreas is a vital digestive organ. However, for this lesson, we will be focusing on the endocrine functions of the pancreas. So, if an endocrine organ secretes hormones directly into the blood, you might be wondering which hormones come from the pancreas? The answer is insulin and glucagon, and as we will see shortly, both help regulate the amount of sugar in your blood, but in opposite ways. Insulin is a hormone that lowers blood sugar levels. It is good to note that it would be equally correct to say that it's a hormone that lowe Continue reading >>
How big is the pancreas?
The pancreas is 12 to 18 centimeters (about 4.7 to 7.1 inches) long and weighs about 70 to 100 grams. The pancreas is made up of a head, a body and a pointy tail. It is located in the upper abdomen behind the stomach. The organ has two major functions. It produces Hormones and enzymes are produced in two different groups of cells: Exocrine pancreas cells Over 99% of the exocrine pancreas cells produce digestive juices – about 1.5 to 2 liters per day. They are called exocrine ("secreting externally") because they secrete digestive juice "externally" into the small intestine. This clear, colorless juice is mainly made up of water and also contains salt, sodium bicarbonate and digestive enzymes. There are enzymes for breaking down fats (lipases), proteins (proteases), and carbohydrates (amylases). Proteases are inactive while inside the pancreas. They are activated once they have been secreted into the small intestine. The sodium bicarbonate neutralizes the acidic gastric (stomach) juice in the mass of semi-digested food to help the digestive enzymes work better. The digestive juices flows from the pancreas through an excretory duct into the small intestine. In most people, this duct joins up with the the excretory duct of the gallbladder before reaching the small intestine. A sphincter muscle at the end of the duct controls the flow of digestive juice into the small intestine. In case of pancreatitis, enzymes may be activated inside the pancreas before reaching the small intestine, causing the gland to start "digesting itself." Endocrine pancreas cells Groups of endocrine cells are spread over the surface of the pancreas. They are called islets of Langerhans, because they are scattered like small islands and were discovered by pathologist Paul Langerhans. These islet ce Continue reading >>
How does the body release insulin?
Your body makes and releases insulin in a feedback loop based on your blood sugar level. At its most basic level, it’s similar to your home's heating and cooling system, which releases cool or warm air as the temperatures rise or fall. High blood sugar stimulates clusters of special cells, called beta cells, in your pancreas to release insulin.
How does insulin affect blood sugar?
The more glucose you have in your blood, the more insulin your pancreas releases. Insulin helps move glucose into cells. Your cells use glucose for energy. Your body stores any extra sugar in your liver, muscles, and fat cells. Once glucose moves into your cells, your blood sugar level goes back to normal. Low blood sugar prompts ...
What hormones are released when blood sugar is low?
Low blood sugar prompts a different cluster of cells in your pancreas to release another hormone called glucagon. Glucagon makes your liver break down the stored sugar, known as glycogen, and release it into your bloodstream. Insulin and glucagon alternate their release throughout the day to keep your blood sugar levels steady.
What does insulin do to your body?
What Insulin Does. Insulin and Diabetes. Insulin is a hormone that helps control your body's blood sugar level and metabolism -- the process that turns the food you eat into energy. Your pancreas makes insulin and releases it into your bloodstream. Insulin helps your body use sugar for the energy it needs, and then store the rest.
Why do people with type 1 diabetes need insulin?
Today, people with type 1 diabetes and some with type 2 diabetes need to take insulin every day to keep their blood sugar levels steady. Getting your blood sugar levels back to normal helps prevent diabetes complications.
What happens to insulin after eating?
What Insulin Does. After you eat, your intestines break down carbohydrates from food into glucose, a type of sugar. That glucose goes into your bloodstream, which makes your blood sugar level rise. Your pancreas is an organ that sits just behind your stomach.
When was insulin first used for diabetes?
Until the early 20th century, the only way to treat type 1 diabetes was with a strict low-carbohydrate, low-calorie diet. In 1921, Canadian surgeon Frederick Banting and his assistant Charles Best discovered insulin. The introduction of insulin as a treatment changed the outlook for people with this disease.
Which organ is responsible for insulin production?
By Editor. The pancreas is an organ located behind the lower part of the stomach, in front of the spine and plays an important part in diabetes. The pancreas is the organ which produces insulin, one the main hormones that helps to regulate blood glucose levels.
Where are insulin cells located?
These cells are distributed in a cluster of cells in the pancreas called the Islets of Langerhans, named after the anatomist who discovered them. Insulin is a hormone that helps to regulate blood sugar levels by assisting the transport of glucose from the blood into neighbouring cells.
What is the role of the pancreas in the body?
The role of the pancreas in the body. The pancreas plays a part in two different organ systems, the endocrine system and the exocrine system. The endocrine system includes all the organs which produce hormones, chemicals which are delivered via the blood to help regulate our mood, growth, metabolism and reproduction.
What is the relationship between type 2 diabetes and pancreas?
The pancreas and type 2 diabetes. In type 2 diabetes, the body builds up resistance to insulin and more insulin is needed to bring down blood glucose levels. As a result the pancreas needs to produce more insulin than it would normally need to. If the pancreas can no longer produce enough insulin to bring down sugar levels, ...
How long does it take for diabetes to show?
Type 2 diabetes comes on gradually and it can take up to years for symptoms to appear.
Which system releases sweat?
The exocrine system is made up of a number of glands which release substances such as sweat (to the skin), saliva (in the mouth) or, in the case of the pancreas, digestive enzymes.
What cells do insulin help?
Almost every cell in your body needs insulin, but it works mostly on the liver, fat and muscle cells. Insulin stimulates your liver and muscle cells to store glucose, while also inhibiting your liver and kidneys from making glucose. It also stimulates your liver and muscle cells to make needed proteins from amino acids. Lastly, insulin helps fat cells form fat.
Is gestational diabetes a type 2 diabetes?
Gestational diabetes is similar to Type 2 diabetes and also leads to higher than normal levels of insulin in your blood. Only pregnant women are susceptible to gestational diabetes, which is thought to occur because hormones present during pregnancy can the woman’s body from properly using its own insulin.
Can a type 2 diabetic have too much insulin?
For people with type I diabetes, the body's pancreas has no beta cells, thus no means to secrete insulin. The pancreatic islets' beta cells could have been destroyed by the immune system, or by genetic or environmental factors. People with type 2 diabetes can secrete insulin, but their bodies don't process it well. As a result, Type 2 diabetics generally have too much insulin in their blood, which leads to insulin resistance.
