Insulin signaling supports nerve metabolism and function via PI3K mediated ATPproduction (31) while impairedsignaling affects T1D and T2D differently: in T2D, insulin resistance limitsmetabolic and bioenergetic function, and compromise axonal growth and myelination inperipheral nerves (19,32), whereas in T1D, preservedinsulin sensitivity allows better neuropathic outcomes with insulin therapy(33). Here, INS is linked to type 1 diabetes mellitus.