INS and obesity due to melanocortin 4 receptor deficiency: A 16-week diet of 1200 kcal per day resulted in a moderate weight loss of approximately 8 kg, which was sufficient to normalize liver lipid content and fasting plasma glucose concentrations as well as reverse hepatic insulin resistance in patients with obesity and type 2 diabetess.31 A potential mechanism explaining the improvement in insulin sensitivity is the reduction in intracellular diacylglycerol levels, which reduce insulin signaling in liver and muscle, leading to tissue-specific insulin resistance.22,32,33