INSR and Insulin resistance: In a rat model of surgical injury and haemorrhage, insulin signalling (IS) is affected in skeletal muscle as soon as 60 min post-surgery, reflected as a rapid decrease of AKT phosphorylation and insulin receptor function.31 Insulin resistance and hyperglycemia in turn, affect immune cells, favouring an inflammatory immune response.32,33 However, the interconnectivity and causation between insulin resistance, hyperglycemia and inflammation needs to be further investigated.