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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]}

An insulin receptor substrate is a docking protein phosphorylated by the activated insulin receptor. Its phosphotyrosine residues recruit downstream signaling proteins, including SH2 domain-containing components of phosphoinositide 3-kinase. This connects reception to the pathway described under insulin, rather than making the insulin receptor substrate another extracellular ligand.^[ref]

The most informative difference is phosphorylation without PDGF, relative to sample A. The following are candidate interpretations of the supplied Western blot, not definitive clinical diagnoses or protein identifications:

A single broad phospho-antibody cannot reliably distinguish the closely sized MEK and ERK bands or determine whether any phosphorylation site is activating. Clinical assessment and genetic and functional confirmation remain necessary.

An activating Ras lesion is a parsimonious candidate, because Ras lies upstream of the branch to Raf and the branch to phosphoinositide 3-kinase. Persistent GTP-bound Ras can therefore produce both basal patterns through a single change. A lesion restricted to MEK would not directly explain the simultaneous Akt signal. The blot does not uniquely locate the mutation: a constitutively active upstream receptor tyrosine kinase or altered regulation of Ras could also activate both branches. Test the Ras nucleotide state, sequence relevant genes, and determine which targeted perturbation suppresses both outputs.

A regulatory subunit associated with a class I phosphoinositide 3-kinase complex. A band of its approximate mass does not establish its identity or whether a detected phosphorylation is activating.