Dihydroceramides are immediate precursors to ceramide synthesis and are negatively related to insulin sensitivity (20, 21) and insulin secretion (21), are positively related to waist circumference (22), are elevated in plasma of individuals with prediabetes and T2D compared with controls (23), and predict development of diabetes 9 years before onset (21). Here, INS is linked to type 2 diabetes mellitus.