[191181] 2581. Young Dolph - Large Amounts (2021)★★∿
[191182] 2582. Wale - Good Vibes (Za) (2021)★★
[191183] 2583. Those Dancing Days - Reaching Forward (2011)★★
[191184] 2584. Those Dancing Days - I'll Be Yours (2011)★★
[191185] 2585. Those Dancing Days - Fuckarias (2010)★★
[191186] 2586. Those Dancing Days - Run Run (2008)★★
[191187] 2587. Those Dancing Days - Those Dancing Days (2007)★★
[191188] 2588. Waxahatchee - Air (2015)★★✚
[191189] 2589. Total Babes - Heydays (2015)★★
[191190] 2590. Times New Viking - Ever Falling In Love (2011)★★__Brandon Reichard
[191191] 2591. The Cribs - Glitters Like Gold (2012)★★
[191192] 2592. The Cribs - Housewife (2010)★★
[191193] 2593. The Cribs - Cheat On Me (2009)★★
[191194] 2594. The Cribs - We Share The Same Skies (2009)★★
[191195] 2595. The Cribs - Moving Pictures (2007)★★
[191196] 2596. The Cribs - Don't You Wanna Be Relevant? (2007)★★
[191197] 2597. The Cribs - Our Bovine Public (2007)★★
[191198] 2598. The Cribs - Martell (2005)★★
[191199] 2599. The Cribs - Hey Scenesters! (2005)★★
[191200] 2600. The Cribs - You're Gonna Lose Us (2005)★★
[191201] 2601. The Cribs - What About Me (2004)★★
[191202] 2602. The Cribs - You Were Always The One (2004)★★
[191203] 2603. Danielle Durack - There Goes My Heart (2021)★★__Kristine Morgan
[191204] 2604. Danielle Durack - Eggshells (2020)★★__Cole Pischke
[191205] 2605. Danielle Durack - Broken Wings (2020)★★__Freddie Paul, Eunice Beck
[191206] 2606. Danielle Durack - Last Summer (2018)★★__Brian Bossert
[191207] 2607. Danielle Durack - San Francisco (2017)★★
[191208] 2608. Danielle Durack - Chasing Pavements (2017)★★
[191209] 2609. Nancy - 7 Foot Tall Post-Suicidal Feel Good Blues (2020)★★
[191210] 2610. Dead Rider Trio & Mr. Paul Williams - Candles on Crabs (2018)★★
[191211] 2611. BigB4 & RxchTrxppShaun - Tom Brady (2021)★★
[191212] 2612. G3ezy - Cappin (2021)★★
[191213] 2613. Hazard - Invest (2021)★★
[191214] 2614. John Carpenter - Alive After Death (2021)★★
[191215] 2615. EBK Young Joc - Ridiculous (2021)★★
[191216] 2616. Bre Musiq - Gang (2021)★★
[191217] 2617. Bill Callahan, Bonnie "Prince" Billy & Ty Segall - Miracles (2021)★★
[191218] 2618. Bill Callahan, Bonnie "Prince" Billy & George Xylouris - Rooftop Garden (2021)★★
[191219] 2619. Bill Callahan - Breakfast (2020)★★
[191220] 2620. The Dodos - Fables (2009)★★
[191221] 2621. Kevan Got Bandz - Mathematics (2021)★★
[191222] 2622. Mozzy - Neva Said It (2021)★★
[191223] 2623. O Racks - Fifty 1 Six (2021)★★
[191224] 2624. Teeth Agency - Anon (2021)★★
[191225] 2625. Destruction Unit - Salvation (2015)★★
[191226] 2626. Lust for Youth - By No Means (2019)★★
[191227] 2627. Pictish Trail - Lead Balloon (2020)★★
[191228] 2628. Hamerkop - Remote (2020)★★
[191229] 2629. Jackie Lynn - Casino Queen (2020)★★__Haley Fohr, Krzys Piotrowski
[191230] 2630. Jane Weaver - The Revolution of Super Visions (2020)★★__Lee Mann
[191231] 2631. Hide, 97Virus & Nicole - 棄愛Babycry (2021)★★
[191232] 2632. Las Kellies - Closer (2020)★★
[191233] 2633. Faten Kanaan - The North Wind (2020)★★
[191234] 2634. Pictish Trail - Slow Memories (2019)★★__Davey Ferguson
[191235] 2635. Ought - Disgraced in America (2018)★★__Heather Rappard
[191236] 2636. Dope Body - Back in Back (2020)★★
[191237] 2637. Psychic Ills - Baby (2016)★★__Jason Evans
[191238] 2638. Psychic Ills - Another Change (2016)★★
[191239] 2639. Spectrals - Get A Grip (2011)★★
[191240] 2640. Sky Larkin - Beeline (2009)★★
[191241] 2641. PAINT - Moldy Man (2018)★★__Sam Kristofski
[191242] 2642. PAINT - Daily Gazette (2018)★★__Sam Kristofski
[191243] 2643. Lissy Trullie - Boy Boy (2009)★★
[191244] 2644. Peaking Lights - Beautiful Son (2012)★★__Geremy Jasper, Georgie Greville
[191245] 2645. Peaking Lights - Dreambeat (2012)★★__Jordan Redaelli, Jason Miller
[191246] 2646. Noveller - Rubicon (2015)★★
[191247] 2647. Peggy Sue - Song & Dance (2011)★★
[191248] 2648. Puro Instinct - Stilyagi (2011)★★__Marcus Herring
[191249] 2649. Simian Mobile Disco - Audacity of Huge (2009)★★__Jo Apps, Kate Moross
[191250] 2650. Saul Williams - Black Stacey (2004)★★
[191251] 2651. Big CEO - Can't Wait (2020)★★
[191252] 2652. Big CEO - ManDown (2020)★★
[191253] 2653. Baby CEO - Reach (2018)★★
[191254] 2654. Baby CEO - Fck Da Oppz (2015)★★
[191255] 2655. Jozef van Wissem & Jim Jarmusch - Etimasia (2012)
[191256] 2656. Ariel Pink - Time To Live (Ариэль Пинк) (2017)★★
[191257] 2657. Ariel Pink & Jorge Elbrecht - Hang On to Life (2013)★★__Alejandro Cardenas, Jorge Elbrecht
[191258] 2658. Giant Giant Sand - Forever and A Day (2012)★★
[191259] 2659. Föllakzoid - Feuerzeug (2015)★★__Domingo García Huidobro
[191260] 2660. FIDLAR - Cheap Beer (2012)★★__Ryan Baxley
[191261] 2661. ANTH & Jared Krumm - Can We Please Go Back (2020)★★
[191262] 2662. ANTH & Conor Maynard - Sunshine (2020)★★
[191263] 2663. ANTH & Conor Maynard - Medicine (2019)★★🆁
[191264] 2664. ANTH - Nobody Else But You (2019)★★
[191265] 2665. Josephine Foster - Pretty Please (2015)★★
[191266] 2666. Allah-Las - Fish On The Sand (2017)★★
[191267] 2667. Allah-Las - Famous Phone Figure (2016)★★
[191268] 2668. Allah-Las - Could Be You (2016)★★
[191269] 2669. Allah Las - Raspberry Jam (2019)★★
[191270] 2670. Conor Oberst - Souled Out!!! (2008)★★
[191271] 2671. Exploded View - Sleepers (2018)★★
[191272] 2672. Exploded View - Summer Came Early (2017)★★
[191273] 2673. Islet - Good Grief (2019)★★__Edwin Burdis
[191274] 2674. Home Blitz - Frozen Track (2012)★★
[191275] 2675. Her Space Holiday - Forever & A Day (2005)★★
[191276] 2676. Mariachi El Bronx - Cell Mates (2009)★★
[191277] 2677. Lovvers - No Romantics (2008)★★
[191278] 2678. Lovvers - Human Hair (2008)★★
[191279] 2679. Los Campesinos! - The International Tweexcore Underground (2007)★★
[191280] 2680. Los Campesinos! - We Throw Parties, You Throw Knives (2007)★★
[191281] 2681. Lace Curtain - Falling (2013)★★__Daniela Velickovic, David West
[191282] 2682. Jorge Elbrecht & Ariel Pink - Called to Ring (2014)★★__Jorge Elbrecht
[191283] 2683. Jorge Elbrecht & Caroline Polachek - I.V. Aided Dreams (2013)★★__Cara Stricker
[191284] 2684. John Carpenter - Vortex (2014)★★
[191285] 2685. Half Japanese - The Beast Master (2020)★★__Jad Fair
[191286] 2686. Half Japanese - The Puppet People (2019)★★__Claus Frøhlich, Jad Fair
[191287] 2687. Globelamp - Washington Moon (2015)★★__Paige Stark, Janell Shirtcliff
[191288] 2688. Globelamp - The Orange Glow (2015)★★
[191289] 2689. Cheatahs - Seven Sisters (2015)★★__Conan Roberts
[191290] 2690. Cheatahs - Coared (2013)★★__Federico Urdaneta
[191291] 2691. Jefre Cantu-Ledesma - Tenderness (2017)★★__Paul Clipson
[191292] 2692. Jefre Cantu-Ledesma - Love After Love (2015)★★__Paul Clipson
[191293] 2693. Lace Curtain - I Can't Wait (2014)★★__David West
[191294] 2694. Las Kellies - Funny Money (2019)★★
[191295] 2695. Las Kellies - Summer Breeze (2016)★★
[191296] 2696. First Aid Kit - You're Not Coming Home Tonight (2009)★★
[191297] 2697. First Aid Kit - Our Own Pretty Ways (2009)★★
[191298] 2698. First Aid Kit - Hard Believer (2009)★★
[191299] 2699. First Aid Kit - Blue Christmas (2008)★★
[191300] 2700. Dungen - Peri Banu vid sjön (2017)★★
[191301] 2701. Dungen - Franks Kaktus (2015)★★
[191302] 2702. Dungen - Åkt Dit (2015)★★
[191303] 2703. Moon Duo - Jukebox Babe (2018)★★
[191304] 2704. Moon Duo - Slow Down Low (2015)★★__Domingo García-Huidobro✚
[191305] 2705. Moon Duo - Free the Skull (2015)★★
[191306] 2706. Mood Rings - The Line (2013)★★
[191307] 2707. Mood Rings - Hollow Dye (Defected Crystal) (2013)★★
[191308] 2708. Peter Matthew Bauer - You Are the Chapel (2014)★★__Brian Melton
[191309] 2709. Peter Matthew Bauer - Philadelphia Raga (2014)★★__Matt Barrick
[191310] 2710. Peter Matthew Bauer - Latin American Ficciones (2014)★★__Matthew Barrick
[191311] 2711. No Age - Feeler (2020)★★__Kersti Jan Werdal
[191312] 2712. No Age - Head Sport Full Face (2020)★★
[191313] 2713. No Age - Turned to String (2020)★★__Jonn Herschend
[191314] 2714. Orchestra of Spheres - Āta (2018)★★
[191315] 2715. Orchestra of Spheres - Trapdoors (2016)★★
[191316] 2716. Orchestra of Spheres - Electric Company (2013)★★__Jay Winebrenner
[191317] 2717. Marching Church - 2016 (2016)★★
[191318] 2718. Marching Church - Heart of Life (2016)★★__Marching Church
[191319] 2719. Marching Church - Lion's Den (2016)★★__Jimmy Durante
[191320] 2720. Marching Church - Your Fathers Eyes (2015)★★__Kristian Emdal
[191321] 2721. Lil Chuang - 戒Leave (2021)★★
[191322] 2722. Lil Slower - 流量 (2021)★★
[191323] 2723. 孟昭融 - Witness (2021)★★
[191324] 2724. Lilacs & Champagne - Maple St. (2014)★★
[191325] 2725. Lilacs & Champagne - Shower Scene (2014)★★
[191326] 2726. Lilacs & Champagne - Sensations (2013)★★
[191327] 2727. Lilacs & Champagne - Everywhere, Everyone (2012)★★
[191328] 2728. Lilacs & Champagne - Lilacs (2012)★★
[191329] 2729. The Blood Brothers - Set Fire To The Face On Fire (2006)★★
[191330] 2730. The Blood Brothers - Lazer Life (2006)★★
[191331] 2731. The Bronx - Knifeman (2008)★★
[191332] 2732. The Bronx - Shitty Future (2006)★★
[191333] 2733. The Bronx - White Guilt (2006)★★
[191334] 2734. The Bronx - History's Stranglers (2006)★★
[191335] 2735. The Bronx - False Alarm (2003)★★
[191336] 2736. The Bronx - They Will Kill Us All (Without Mercy) (2003)★★
[191337] 2737. 愛吃西瓜的鑑黃師:2020年日本作品銷量最高的十位女優 (2021)★★
[191338] 2738. 羅卡:進擊的巨人2 Nintendo Switch開箱 (2018)★
[191339] 2739. 平民遊戲工作室:進擊的巨人2值得買嗎? (2018)★★
[191340] 2740. 餓模人:GSC 好微笑 Mecha Smile THE合體展 in 台灣 模型格納庫 1/22-1/24 免費入場 (2021)★★
[191341] 2741. Bloc Party - One More Chance (2009)★★
[191342] 2742. Bloc Party - One Month Off (2009)★★
[191343] 2743. Bloc Party - Mercury (2008)★★
[191344] 2744. Bloc Party - Talons (2008)★★
[191345] 2745. Bloc Party - The Prayer (2007)★★
[191346] 2746. Bloc Party - I Still Remember (2007)★★
[191347] 2747. Bloc Party - Flux (2007)★★
[191348] 2748. Bloc Party - So Here We Are (2005)★★
[191349] 2749. Bloc Party - Tulips / The Pioneers (2005)★★🆁
[191350] 2750. Bloc Party - Banquet (2004)★★
islet cell 在 運動營養師 楊承樺 Facebook 的最佳貼文
好文分享,王醫師結論:
1. 胰島素阻抗是人體的一種保護機制,如果人體沒有胰島素阻抗,#心肌 受到的損害更大,你更「早死」。如果人體沒有胰島素阻抗,#骨骼肌 受到的損害更大,你 #活動會受限,你更「早死」。以長期的觀點來看,胰島素阻抗保護你的「心臟」,讓你能持續活下來,保住你的「骨骼肌」,希望你能多增加體能活動,降低所謂的 #熱量中毒狀態(Caloric intoxicated state)。
2. 糖尿病的治療的大方向除了藥物治療之外,#一定要配合生活型態的改變,#減少高熱量高精緻飲食,#少添加糖及 """#增加體能活動""" 等。
胰島素阻抗是人體的一種保護機制?
現代化社會中的人們由於飲食及生活型態的影響,罹患糖尿病的人口迄今不斷攀升,而目前有一些學者認為胰島素阻抗,從進化的角度來看原本是人類生存中的一種生理適應保護機制 。但在現代文明環境下(高熱量高精緻飲食及低體能活動等)這樣的機制被持續慢性的被激活,最終導致第II型糖尿病。
近年來有學者提出了關於II型糖尿病致病機制的新假設,就是所謂的熱量中毒(Caloric intoxication).
在目前的環境中,高熱量攝取,低體力活動和慢性壓力等,造成脂肪組織中多餘脂肪的儲存遠遠超過其儲存能力和脂質調節。然而脂肪儲存庫中的脂質過載,而導致脂肪細胞功能障礙及引發脂質溢出至週圍組織,造成整體的慢性發炎狀態。
然而,當營養熱量不再以安全的方式儲存時,就會造成多餘能量的異位儲存(Ectopic fat storage),特別是儲存在胰臟或肝臟中的內臟脂肪,這是在第II型糖尿病的發展中起著重要作用。
第II型糖尿病的特徵在於體循環中葡萄糖,脂質和游離脂肪酸的水平逐漸增加,其對體內的細胞和組織具有毒性作用,即所謂的醣脂毒性(Glucolipotoxicity):換言之,就是所謂的熱量中毒狀態(Caloric intoxicated state)。
重點來了,目前的研究認為人體產生胰島素阻抗是為了保護心肌細胞。心臟為了保護心肌細胞免於心肌細胞能量毒性損傷(Myocardial fuel toxicity),產生了胰島素阻抗,不要讓過多的能量進入心肌細胞,造成心臟損傷。簡單來說就是如果沒有胰島素阻抗,你也活不了了。
在誘導胰島素抗性的初期及中期,胰臟的β細胞通過增加胰島素產生來響應以將血糖維持在正常水平,這就是所謂的高胰島素血症(Hyperinsulinemia)。這使得身體能夠在不同特異性的器官組織之間分配能量,例如在脂肪組織中增加的相對胰島素效應和增加的能量儲存,同時心臟受到更好的保護。
我們可以看得出來這是身體的兩難,一方面增加胰島素阻抗一方面又增加更多胰島素的生產,這是為了心臟的防禦也增加了其他器官的負擔。
到了胰島素抗性的中晚期,就是所謂的胰島素分泌衰竭期,一旦進入這個階段,大多數的糖尿病患者都需要用胰島素治療來控制好血糖。
目前越來越多證據顯示致肥胖環境(高精緻飲食及低體能活動等)( Obesogenic environment),基因及表觀基因(epigenetics),引發胰島β細胞的高反應性(hyper-responsiveness Islet β-cell) 而導致高胰島素血症(Hyperinsulinaemia)。這也是造成「胰島素抗性」及「代謝症候群」主要驅動因素。圖二
而代謝症候群或高胰島素血症(Hyperinsulinaemia)也引發了這些下游的慢性疾病,例如:第II型糖尿病(T2D),心血管疾病(CVD),非酒精性脂肪性肝病/非酒精性脂肪性肝炎(NAFLD / NASH)和多囊卵巢綜合徵(PCOS)等。
這裡有個小故事.
你可以把「人體」想像成一個「小宇宙」,人體的每顆「細胞」就是小宇宙中的「星球」。然而在小宇宙星球上的「人口」就等於身體中的「熱量」(葡萄糖,脂質和游離脂肪酸)。當小宇宙中或星球的人口(熱量)不斷的增加,這等同於人體細胞熱量中毒狀態(Caloric intoxicated state).在這種情況下,細胞(星球)將面臨滅亡。
人體(宇宙)為了存活,起動了「薩諾斯(Thanos)模式」,就是所謂的「胰島素抗性」。這讓宇宙中的星球(細胞)中人口(熱量)減半,來減緩宇宙或星球的毀滅。
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以下將更進一步的討論糖尿病治療的概念框架,主要內容來自以下這篇論文。個人認為非常值得參考。
Insulin resistance and insulin hypersecretion in the metabolic syndrome and type 2 diabetes:Time for a conceptual framework shift
https://doi.org/10.1177/1479164119827611
目前有學者把糖尿病分成五種類型,包含嚴重自體免疫 (SAID),嚴重胰島素缺乏 (SIDD),嚴重胰島素阻抗 (SIRD),輕微肥胖相關 (MOD)及輕微年齡相關 (MARD)。
以下這篇論文將糖尿病更簡單的分成兩種。
1. 未治療的高胰島素血症第II型糖尿病(untreated type 2 diabetes (T2D) with hyperinsulinaemic diabetes)。
2. 未治療的低胰島素血症第II型糖尿病(untreated hypoinsulinaemic T2D)。
而我們人體中的對胰島素的反應也可以分成兩種細胞。
1. 胰島素反應細胞(insulin-responsive cells): 心肌細胞和骨骼肌細等。
2. 胰島素無反應細胞(insulin non-responsive cells): 內皮細(Endothelial cells),大小血管等。
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(A) 未治療的高胰島素血症第II型糖尿病(untreated type 2 diabetes (T2D) with hyperinsulinaemic diabetes)。
在(a)左圖我們可以觀察到胰島素抗性(IR)保護胰島素反應細胞,例如心肌細胞和骨骼肌細胞免受營養熱量過載,不要讓過多的能量進入心肌細胞,造成心臟損傷。 然而,人體的高血糖對胰島素無反應的細胞如內皮細胞(大小血管等)不受保護作用,長期下來就會導致心血管疾病、腦血管疾病、視網膜病變、神經病變及腎病變等慢性疾病。
而(a)中圖的情況是通過高劑量胰島素治療,來降低胰島素抗性(IR).而這種情況可以「降低胰島素無反應細胞」(insulin non-responsive cells) 損傷,但「胰島素反應細胞」(insulin-responsive cells)就無法受到保護,心肌細胞就會受到營養熱量過載的影響,引發所謂的代謝心肌病變(metabolic cardiomyopathy)。這是人體的兩難,這或許是為什麼一些研究認為非常嚴格控制血糖,反而有較高死亡率。
Effects of intensive glucose lowering in type 2 diabetes.
N Engl J Med 2008; 358: 2545 – 59.
Effects of intensive glucose lowering in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
Circulation 2010; 122: 844 – 6
(a)右圖是一般認為最好的情況.
1. 透過減少葡萄糖進入血液: 減少高熱量高精緻飲食,低糖飲食,α-葡萄糖苷酶抑製劑(α-glucosidase inhibitors)及減肥手術等。
2. 透過一些途徑讓葡萄糖從血液中清除: 生活型態改變,增加體能活動,運動,SGLT2抑製劑促進尿液葡萄糖排出和激活棕色脂肪組織等)。
這種雙管齊下的作法,可以避免所有胰島素反應或無反應細胞的組織損傷,也可以得到最佳的血糖控制狀態。
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(B) 未治療的低胰島素血症第II型糖尿病(untreated hypoinsulinaemic T2D)。
在(b)左圖發生對低胰島素的飢餓反應下,其中游離脂肪酸(FFA)從脂肪組織釋放增加,肝酮體產生增加;心肌細胞和骨骼肌細胞缺乏葡萄糖,轉而使用FFA和酮體作為能量.然而內皮細胞未受到高血糖的保護。
(b)中圖,在這種情況下,「胰島素治療」將防止飢餓反應(starvation response),使胰島素反應細胞(insulin-responsive cells): 心肌細胞和骨骼肌細等營養狀態正常化並防止內皮細(Endothelial cells)的葡萄糖毒性。
(b)右圖,運用嚴格降低血中葡萄糖降低的方法,即從細胞中卸載葡萄糖(例如通過非常低的碳水化合物飲食或禁食)以及血液中的葡萄糖清除(例如SGLT2抑製劑)將加劇低胰島素血症T2D中的飢餓反應並誘導血糖正常的酮症酸中毒(Euglycaemic ketoacidosis)。
我個人認為生酮飲食或極低碳飲食在「低胰島素血症第II型糖尿病」這一類的病人還是會有風險的,特別是這類的患者實行生酮飲食又加上斷食,或者有加上SGLT2抑製劑等藥物,會引發酮酸中毒的機率就會增加。以下已經有一些論文或個案的發表.
Life-threatening ketoacidosis in patients with type 2 diabetes on LCHF diet
Bonikowska K, et al. Lakartidningen. 2018
Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report
doi: 10.1186/s13256-015-0709-2
EUGLYCEMIC DIABETIC KETOACIDOSIS WITH SGLT2 INHIBITOR USE IN A PATIENT ON THE ATKINS DIET: A UNIQUE PRESENTATION OF A KNOWN SIDE EFFECT
https://doi.org/10.4158/EP171860.CR
結論:
1. 胰島素阻抗是人體的一種保護機制,如果人體沒有胰島素阻抗,心肌受到的損害更大,你更「早死」。如果人體沒有胰島素阻抗,骨骼肌到的損害更大,你活動會受限,你更「早死」。以長期的觀點來看,胰島素阻抗保護你的「心臟」,讓你能持續活下來,保住你的「骨骼肌」,希望你能多增加體能活動,降低所謂的熱量中毒狀態(Caloric intoxicated state)。
2. 糖尿病的治療的大方向除了藥物治療之外,一定要配合生活型態的改變,減少高熱量高精緻飲食,少添加糖及增加體能活動等。
3. 糖尿病患者實行任何飲食法最好能夠和臨床醫師討論,進一步減少一些沒有必要的風險。
#胰島素阻抗
#高胰島素血症
#糖尿病
參考資料:
Insulin resistance and insulin hypersecretion in the metabolic
syndrome and type 2 diabetes:Time for a conceptual framework shift
https://doi.org/10.1177/1479164119827611
Insulin Resistance as a Physiological Defense Against Metabolic Stress: Implications for the Management of Subsets of Type 2 Diabetes
doi: 10.2337/db14-0694
Insulin resistance is a cellular antioxidant defense mechanism
doi: 10.1073/pnas.0902380106
Insulin Resistance and Aging: A Cause or a Protective Response?
doi:10.1093/gerona/gls145.
Insulin resistance: An adaptive mechanism becomes maladaptive in the current environment — An evolutionary perspective
https://doi.org/10.1016/j.metabol.2012.11.004
Insulin resistance protects the heart from fuel overload in dysregulated metabolic states
doi: 10.1152/ajpheart.00854.2012
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