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Impaired transport of blood sugar into muscle cells appears to be responsible for insulin resistance in people with type 2, or adult-onset, diabetes. Insulin resistance means that insulin does not stimulate the metabolism of blood sugar inside the muscle cell as it normally does in a person without diabetes. In a study of seven healthy people and six people with type 2 diabetes, the rate of blood sugar metabolism in muscle cells was 80% lower than in the healthy people. This appeared to be a result of decreased transport of blood sugar into the cell rather than a defect in the activity of enzymes involved in sugar metabolism.

A case is described of a 31-year-old woman who did not have the usual physiological response to hypoglycemia because she had sarcoidosis in her hypothalamus. Normally when blood sugar levels fall, an area of the brain called the hypothalamus produces hormones that raise blood sugar levels. During hospital examination for other problems, this woman was found to have low blood sugar levels even though she had no symptoms of hypoglycemia. She had a history of sarcoidosis, a disease that usually affects the lungs but can also occur in other tissues. In her case, the disease had spread to her hypothalamus.