Lactate is an important metabolite in the glycolytic pathway, and research has shown that muscle lactate/pyruvate metabolism is altered in obese, non-insulin-dependent DM patients with fasting HG thereby impacting insulin sensitivity.26, 28 A progressive and proportional increase in plasma lactate levels has been shown in oral glucose tolerance test, hyperinsulinaemic-euglycaemic clamp studies, as well as epidemiological studies, implying that lactate may serve as an early marker of insulin resistance long before a diagnosis of DM, especially in those with a BMI>30 kg/m2. This evidence concerns the gene INS and Insulin resistance.