C18:0 in skeletal muscle has been shown to cause insulin resistance in obese mice, and deficiency of the enzyme (ceramide-synthase-1—CerS1) producing C18:0 in skeletal muscle has been shown to be protective of insulin resistance in different studies.38,39 Whether BMI-lowering lifestyle modifications and novel enzyme inhibitors for ceramide synthases might contribute to normalization of ceramide levels in CCS are important questions that need to be addressed in future studies.40,41. This evidence concerns the gene CERS1 and Insulin resistance.