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Insulin is a protein hormone. Its mature form has two polypeptide chains; identifying their sequences and protein disulfide bonds provided the motivating example in Sanger's insulin sequencing experiment. See Cooper: insulin as a two-chain hormone, figure 2.16.

A meal illustrates the insulin side of blood glucose homeostasis: rising glucose stimulates beta cells in the pancreatic islets, and released insulin favors uptake and storage of fuel. Alpha cells produce glucagon, while delta cells produce somatostatin, which inhibits release of both insulin and glucagon. The pancreas therefore contains interacting sensor and secretory biological cells, rather than one undifferentiated source of hormones. ^[ref]

Insulin and glucagon are peptide hormones, built from amino acid residues joined by peptide bonds; glucose is a small carbohydrate molecule. A hormone changes signal transduction, not the identity of the fuel it regulates. Human mature insulin has 51 amino acid residues in two polypeptide chains. Beta cells process proinsulin to insulin and C-peptide, storing the products in secretory granules for exocytosis. Increased glucose metabolism raises the ATP-to-ADP ratio, tending to close ATP-sensitive potassium channels; depolarization and entry of calcium ions then trigger exocytosis. This is an important triggering pathway, with additional amplification and modulatory inputs.^[ref]

Binding to the insulin receptor, a receptor tyrosine kinase, starts phosphorylation of the receptor and insulin receptor substrates. Recruitment of phosphoinositide 3-kinase and activation of Akt transmit a major metabolic branch. In skeletal muscle and adipose tissue, that branch helps move GLUT4 to the cell membrane, increasing glucose uptake by facilitated diffusion. GLUT4 is a membrane transport protein, not an insulin receptor. Insulin also favors glycogenesis in skeletal muscle and the liver, and inhibits lipolysis in adipose tissue. In the liver, suppression of glucose output involves enzyme regulation, gene expression, and indirect changes in substrate supply. Its relative direct and indirect contributions are more complex than a single Akt arrow. ^[ref]

Insulin is not a universal permission slip for glucose entry: red blood cells and much of the nervous system use uptake mechanisms that are not acutely dependent on insulin. Nor does the liver use the same GLUT4 switch as skeletal muscle. This is why reduced insulin action can change blood glucose dramatically without stopping all glucose uptake. ^[ref]

Diabetes can disrupt production, response, and counterregulation. Type 1 diabetes usually involves destruction of beta cells and severe loss of endogenous insulin; type 2 diabetes combines insulin resistance with insufficient beta cell compensation. High circulating insulin can therefore coexist with impaired insulin action. Inappropriate glucagon release can add to excessive liver glucose output, and the response to low blood glucose can also be impaired: "more glucagon" is not a complete description of diabetes. These distinctions explain mechanisms, rather than prescribe treatment. ^{[ref] [ref]}

Location determines access to substrates, cofactors and transport routes; identical catalytic potential can therefore serve different physiological functions in different compartments. In carbohydrate metabolism, the plasma membrane, mitochondrion and endoplasmic reticulum are selective barriers, not merely containers. A soluble enzyme cannot use a metabolite efficiently if that metabolite cannot reach its compartment, while transporter abundance matters chiefly when the transporter is in the appropriate membrane.

Most glycolysis occurs in the cytosol, whereas pyruvate dehydrogenase complex and much oxidative metabolism occur in the mitochondrial matrix. Pyruvate entry therefore links cytosolic glucose breakdown to mitochondrial oxidation. Cytosolic NADH does not freely cross the inner mitochondrial membrane: the malate-aspartate shuttle and glycerol phosphate shuttle transfer reducing equivalents through different routes. Their operation affects the energetic outcome of glucose use. In gluconeogenesis, mitochondrial pyruvate carboxylase produces oxaloacetate, but oxaloacetate itself does not freely cross that membrane. Conversion into transportable intermediates, or formation of phosphoenolpyruvate in the appropriate compartment, allows carbon to reach cytosolic steps. Enzyme localization thus imposes an obligatory transport and redox problem, not just an extra reaction label.

At the final step of hepatic glucose production, the catalytic site of glucose-6-phosphatase faces the endoplasmic-reticulum lumen. Glucose-6-phosphate must reach it through the associated transport system. Hydrolysis makes free glucose available for export, whereas the phosphate ester is largely retained by membranes. Muscle can mobilize cytosolic glycogen to glucose-6-phosphate for its own glycolysis, but lacks the hepatic glucose-6-phosphatase system needed for substantial release of that carbon as free blood glucose. Tissue function therefore depends on both enzyme expression and the membrane machinery surrounding the enzyme.

Transporter traffic changes function without waiting for new protein synthesis. In resting muscle and adipose cells, much GLUT4 resides in intracellular vesicles. Insulin signalling promotes its delivery to the cell surface and increases glucose uptake; internalization subsequently reduces surface transport capacity. Classical membrane-fractionation and transport-site measurements supported redistribution from an intracellular pool to the plasma membrane.^[ref] Fractionation requires compartment markers, and surface labelling or microscopy provides an independent check: altered fraction recovery alone could otherwise mimic redistribution. Total cellular GLUT4 is not an adequate proxy for surface uptake capacity.

Polarity provides another example. In intestinal epithelial cells, apical SGLT1 uses the sodium electrochemical gradient to take up glucose, whereas basolateral GLUT2 enables exit towards the circulation. Basolateral sodium-potassium ATPase maintains the sodium gradient. Misplacing a transporter can disrupt vectorial absorption despite normal intrinsic transport activity. Glycogen-associated regulatory enzymes similarly gain access to a localized substrate pool. These examples show why localization should be tested with activity and transport measurements as well as images. Compartmentation creates direction, regulation and tissue specialization, while requiring transporters that connect the separated reactions.