Insulin to type 2 diabetes mellitus: friend or foe?

Insulin is the sole hypoglycemic hormone in the body, and its deficiency can lead to type 1 diabetes mellitus, while the pathogenesis of type 2 diabetes mellitus (T2DM) is associated with hyperinsulinemia and insulin resistance. We recently found that metabolic surgery significantly reduced insulin production and action, but blood glucose remained normal in healthy rats; metabolic surgery also reduced energy intake and increased its consumption, as well as promoted AMPK expression, fatty acid oxidation, gluconeogenesis and glycolysis. Its strong hypoglycemic effect has also been demonstrated in rats with islet destroy and T2DM patients. Based on these findings, we propose that T2DM is a metabolic disorder that results in excessive intake or reduces consumption of energy, which then leads to abnormal insulin function and secretion, thereby impairs energy sensor and utilization, and finally causes the multiple metabolic disorders and complications. Therefore, insulin resistance and insufficiency may be a warning and protective mechanism for T2DM. Maintaining low energy and insulin status can effectively prevent the development of T2DM