Hence, 3HB appears to interfere with cardiomyocyte insulin sensitivity not only at the level of v-ATPase assembly (causing CD36-mediated lipid accumulation and lipid-induced insulin resistance) but also at an additional level, which could be direct inhibition of insulin signaling, most likely at the level of Akt2, as suggested previously [20,21]. This evidence concerns the gene CD36 and Insulin resistance.