INS and metabolic dysfunction-associated steatotic liver disease: In its natural course, insulin secretion increases temporarily, accompanied by secondary IR and progressive loss of beta cell mass.[1] Metabolic disturbances accompanying obesity and dysfunction of the musculo–hepatopancreatic axis lead to the development of T2DM.[2] Nonalcoholic fatty liver disease (NAFLD) occurs when the fat exceeds 10% to 5% of the weight of the liver.