Metabolic and biological changes in children with obesity and diabetes

Figure 2 Insulin signaling pathway. After insulin binds to the insulin receptor, which is a type of tyrosine kinase, signal transduction mediated by insulin-receptor substrate-1, PI3K, and AKT is activated by phosphorylation. AKT phosphorylates the Ser9 site of GSK-3b, which inhibits glycogen synthetase (GS). Hence, the insulin signaling pathway leads to glycogen synthesis. AMPK and MTOR are major modulators in metabolism. Insulin resistance and branched-chain amino acids are indicated to influence these mediators.