INS and ischemia: However, recent studies have proposed that ischemia and insulin would trigger independent pathways of the translocation of glucose transporters (GLUTs) in the myocardium, to increase glucose transport to the myocyte: ischemia leads to GLUT-4 translocation via a phosphatidylinositol 3-kinase (PI3-kinase)-independent mechanism, and insulin via a PI3-kinase-mediated pathway [21, 22].