INS and metabolic dysfunction-associated steatotic liver disease: In liver biopsies from individuals with NAFLD, gene expression analyses revealed a lower ratio between the IR isoforms type A and B, with potential implications for downstream insulin signaling, and lower IRS-2 mRNA expression compared with individuals with normal liver TG [44,45], while gluconeogenic enzymes as glucose-6-phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK) were increased [45,46].