INS and Insulin resistance: IMCL accumulation is associated with insulin resistance (IR)3–5, but the occurrence of increased IMCL also in states of high insulin sensitivity (the ‘athlete’s paradox’)6 has focused attention on related lipid intermediates (e.g. ceramide, diacylglycerol or long-chain fatty acyl CoA), rather than intramyocellular triglyceride (TG) per se, in impaired insulin signalling2.