INS and familial dilated cardiomyopathy: Under normal physiological conditions, mitochondrial OXPHOS accounts for the vast majority of cardiac ATP requirements; however, in the presence with insulin resistance, myocardial use of insulin-stimulated glucose uptake and glucose utilization is reduced and fatty acid uptake and oxidation rates are increased, and this altered substrate preference plays an essential role in the pathophysiology of DCM (103–105).