INSR and diabetic kidney disease: Insulin resistance is the most common and widespread molecular mechanism of diabetic complications, not only in the high glucose state with extensive activation of insulin receptor signaling pathways, such as the regulation of glucose uptake by GLUT.438 Even in the presence of normal blood glucose, insulin resistance is still harmful, and the lack of insulin receptor signaling pathways in renal pedal cells induces a disease state similar to diabetic nephropathy.439