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Physiol Behav (2011) 105(1):413.10.1016/j.physbeh.2011.02.010 27 JeonTIZhuBLarsonJLOsborneTF

55 Together, the combined actions of various disorders in the proximal signaling components leads to impaired glucose metabolism and IR, and a major challenge remains for understanding IR mechanisms regarding how to distinguish the causes from insulin effects or primary defects from their consequences

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For l-carnitine interactions , clinicians must rely on mechanistic studies, case reports, small clinical studies, and pharmacologic reasoning